2017-02-06T16:35:24-06:00 2016-07-31 910614823 SCHOEDEL & SCHOEDEL CPAS PLLC 422 W RIVERSIDE AVE STE 1420 SPOKANE WA 992010395 990 2015-08-01 201842198 SEIU Healthcare NW Health Benefits Trust SEIU 4257717359 PO Box 6 Mukilteo WA 98275 Charissa Raynor Executive Director 2538153728 2017-02-06 1 SCOTT OPPERUD CPA P00542597 5097472158 2017-02-06 2015 2021-01-29 14:40:06Z Sterling Harders PO Box 6 Mukilteo WA 98275 190079616 0 X www.myseiubenefits.org X 2004 WA The Trust was established as a result of collective bargaining between the Service Employees International Union, Local 775 (SEIU 775) and various employers or employer representatives signatory thereto to provide health, vision and dental benefits covering qualified employees reported under the collective bargaining agreements. 10 10 0 0 0 0 0 0 168660388 190041199 397 38417 0 0 168660785 190079616 0 0 148524734 124180837 0 0 0 0 0 4834052 7128097 153358786 131308934 15301999 58770682 42304399 101666349 534327 1125595 41770072 100540754 The Trust provides health and welfare benefits pursuant to collective bargaining agreements between various employers and the Trust. 0 0 The Trust was established as a result of collective bargaining between SEIU 775 and various employers or employer representatives signatory thereto to provide health, vision and dental benefits covering qualified employees reported under the collective bargaining agreements. 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 13 0 1 0 0 0 0 0 0 0 X 10 10 1 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Benefit Solutions Inc 4257717359 12121 Harbour Reach Drive Ste 105 Mukilteo WA 98275 X Sterling Harders Labor Trustee 1.00 X 0 0 0 Misha Werschkul Labor Trustee 1.00 X 0 0 0 Seth Hemond Labor Trustee 1.00 X 0 0 0 Eric Erickson Employer Trustee 1.00 X 0 0 0 Adam Glickman-Flora Labor Trustee 1.00 X 0 0 0 Diane Lutz Employer Trustee 1.00 X 0 0 0 Shaine Truscott Labor Trustee 1.00 X 0 0 0 Monique Taylor Swan Labor Trustee 1.00 X 0 0 0 Bill Moss Employer Trustee 1.00 X 0 0 0 Mark Robinson Employer Trustee 1.00 X 0 0 0 Charissa Raynor Executive Director 10.00 X 0 168419 45624 0 168419 45624 0 0 1 0 SEIU Healthcare NW Training Partnership 215 Columbia Street Seattle WA 98104 Plan administration 3563183 Benefit Solutions Inc 12121 Harbour Reach Drive Suite 10 Mukilteo WA 98275 Contract administrator 1580114 Delta Dental of Washington 9706 Fourth Avenue NE Seattle WA 981152157 Dental claims administrator 366032 SEIU HEalthcare 775NW 215 Columbia Street Seattle WA 98104 MRC fees 255370 Brown & Brown of WA 1501 Fourth Ave Ste 2400 Seattle WA 98101 Consulting 234583 5 Employer contributions 525100 184306013 184306013 Participant contributions 525100 5735186 5735186 190041199 38417 38417 190079616 190041199 0 38417 124180837 2201516 28668 30060 4226444 61463 280312 198334 56810 4391 11049 Dues 29050 131308934 23902396 14212680 0 53479208 18388632 19889281 13371 144577 0 13940603 42304399 101666349 138527 537880 395800 587715 534327 1125595 X 0 0 0 0 41770072 100540754 41770072 100540754 42304399 101666349 58770682 0 X 0 1 X 0 0 0 INSURANCE CONTRACT RESERVES 13940603 13940603 Dental claims payable 98400 Premiums due to insurers 259715 Dental claims incurred but not reported 229600 587715 190079616 0 190079616 0 190079616 131308934 0 131308934 0 131308934 1 0 0 0 Charissa Raynor Executive Director 0 168419 0 0 0 0 0 33684 0 11940 0 214043 0 0 SEIU Healthcare NW Training Partnership Trustees in common The SEIU Healthcare NW Training Partnership provides certain administrative services to the SEIU Healthcare NW Health Benefits Trust. Payments for these services totaled $3,563,183 for the year. 0 SEIU Healthcare 775NW Common management and governance SEIU Healthcare 775NW provides a member resource center benefiting the SEIU Healthcare NW Health Benefits Trust. Payments for these services totaled $255,370 for the year. 0 Form 990, Part VI, Section A, line 2 SEIU Healthcare 775NW and the SEIU Healthcare NW Training Partnership are service providers to this trust as well as participating employers. David Rolf was the Chairman of this trust, is the President of SEIU Healthcare 775NW, and is the Chairman of the SEIU Healthcare NW Training Partnership. Seth Hemond is a trustee of this trust, an employee of SEIU Healthcare 775NW, and a trustee of the SEIU Healthcare NW Training Partnership. Sterling Harders is a trustee of this trust, the Vice President of SEIU Healthcare 775NW, and a trustee of the SEIU Healthcare NW Training Partnership. Adam Glickman-Flora is a trustee of this trust, the Secretary-Treasurer of SEIU Healthcare 775NW, and a trustee of the SEIU Healthcare NW Training Partnership. Shaine Truscott is a trustee of this trust and an employee of SEIU Healthcare 775NW. Bill Moss is a trustee of this trust and a trustee of SEIU Healthcare NW Training Partnership. Monique Taylor Swan is a trustee of this trust and an executive board member of SEIU Healthcare 775NW. Charissa Raynor is the Executive Director of this trust and the Executive Director of the SEIU Healthcare NW Training Partnership. Form 990, Part VI, Section A, line 3 The Trust has contracted with various organizations (Benefit Solutions, Inc., Delta Dental of Washington, SEIU Healthcare NW Training Partnership, and SEIU Healthcare 775NW) to provide administrative, bookkeping, claims processing, member communications, and record keeping services. Form 990, Part VI, Section A, line 7a Any vacancies of Employer Trustees are filled by appointment of the remaining Employer Trustees. The appointment of an Employer Trustee may be terminated, at any time, by the remaining Employer Trustees by such method as is satisfactory to them. Any vacancies of the Labor Trustees are filled by appointment of the president of SEIU Healthcare 775NW according to SEIU Healthcare 775NW's internal rules, procedures, policies or bylaws. The appointment of a Labor Trustee may be terminated, at any time, by the president of SEIU Healthcare 775NW according to SEIU Healthcare 775NW's internal rules, procedures, policies or bylaws. Form 990, Part VI, Section B, line 11 The Form 990 was prepared by the independent accounting firm SCHOEDEL & SCHOEDEL, Certified Public Accountants, PLLC from information provided by the third-party administrator and other consultants and advisors. Draft copies of the Trust's financial statements and Form 990 were first provided to the Trust's consultants and advisors, who reviewed the Form 990 for accuracy and completeness. Any questions, concerns or issues raised by the consultants and advisors were addressed and any necessary revisions were made to the Form 990. The revised Form 990 was then provided to the Board of Trustees for its review and approval. Any additional questions, concerns or issues raised by the Board of Trustees were addressed and any necessary revisions were made to the Form 990. The final version of the Form 990 was reviewed, approved and filed by the Board of Trustees. Form 990, Part VI, Section B, line 12c A copy of the Trust's Conflict of Interest Policy has been distributed to each Trustee and other fiduciaries. At least annually, a fiduciary is obligated to disclose or update to the Board of Trustees a list of relatives as defined in the policy involved in any transaction, as well as the fiduciary's business or other interests in any transaction impacting Trust assets (except for the receipt of benefits under the terms of the trust and plan). Further, any fiduciary who has knowledge of any transaction that may arguably be restricted pursuant to the policy, and that has not been specifically permitted by ERISA Section 408 or Department of Labor administrative exemptions, is obligated to disclose such information to the Board of Trustees. The Board of Trustees investigates any actual or potential conflicts of interest. If the Board of Trustees determines that a conflict exists with respect to a fiduciary, it will prohibit the fiduciary from discussions, votes, or attempts to influence the issue or decision that is impacted. Form 990, Part VI, Section B, line 15 There are no compensated management officials, officers or key employees of the organization. If the organization had such compensated individuals, policies and procedures would be developed to determine compensation. Form 990, Part VI, Section C, line 19 The Trust's governing documents, conflict of interest policy, financial statements, and Form 990 are available to the general public upon written request sent to Benefit Solutions, Inc. at P.O. Box 6, Mukilteo, WA 98275. Form 990, Part VII, Section A, Line 1A: None of the Trustees are compensated by the organization. The Board of Trustees is comprised of ten individuals, four of whom are representatives of the employers and six of whom are respresentatives of the union. In their roles as Trustees, all are fiduciaries and understand their obligations under the Trust Agreement and the Trust's policies and procedures, which include a conflict of interest policy. The Trust does not readily have access to information related to compensation paid by other entities to the Trustees. Coastal CAP 117 East Third Aberdeen WA 98520 Home care services WA 501(c)(3) Line 7 N/A 0 Concerned Citizens PO Box 1787 Forks WA 98331 911156809 Home care services WA 501(c)(3) Line 7 N/A 0 Korean Women's Association 123 E 96th Street Tacoma WA 98445 Home care services WA 501(c)(3) Line 9 N/A 0 SEIU Healthcare NW Training Partnership 215 Columbia Street Suite 300 Seattle WA 98104 510673005 To provide comprehensive training, support, and career development benefits. WA 501(c)(3) Line 2 N/A 0 SEIU Healthcare 775NW 215 Columbia Street Seattle WA 98104 810588837 Local union representing home care and nursing home workers. WA 501(c)(5) N/A 0 SEIU 925 Multiemployer Health Benefits Trust PO Box 6 Mukilteo WA 98275 To provide health benefits for participants WA 501(c)(9) N/A 0 State of Washington - Department of Social and Health Services PO Box 45842 Olympia WA 98504 To improve safety and health of individuals, families, and communities. WA N/A 0 CDM Caregiving Services 2409 Broadway Vancouver WA 98663 Home care services WA 501(c)(3) Line 7 N/A 0 Working Washington 719 3rd Avenue Seattle WA 98104 To build a powerful workers movement WA N/A 0 Addus Health Care 1121 N Argonne Road Spokane WA 99212 Home care services WA N/A C 0 Amicable Healthcare Inc 15220-B 32nd Avenue South SeaTac WA 99188 Home care services WA N/A S 0 Capital Opportunities PO Box 877 Bozeman MT 59771 Home care services MT N/A C 0 Catholic Community Services 100 23rd Ave S Seattle WA 98144 Home care services WA N/A S 0 Chesterfield Services Inc 703 Columbia Street Suite 200 Seattle WA 98104 Home care services WA N/A C 0 Olympic Community Action Programs 803 West Park Avenue Port Townsend WA 98368 Home care services WA N/A C 0 ResCare of WA 747 St Helens Avenue Suite 200 Tacoma WA 98402 Home care services WA N/A C 0 Senior Life Resources Northwest 8656 West Gage Blvd Suite 301 Kennewick WA 99336 Home care services WA N/A C 0 Fidelis Senior Care 2030 Main Street Irvine CA 92614 Home care services CA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1