SEIU HEALTHCARE NW HEALTH BENEFITS TRUST: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- SEIU HEALTHCARE NW HEALTH BENEFITS TRUST (EIN 20-1842198)
- Tax period
- 2012-08-01 to 2013-07-31
- Filed
- 2014-06-13
- IRS object ID
- 201431649349300783
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-06-13T13:24:07-05:00 | Timestamp |
| Tax Period End Date | 2013-07-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910614823 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHOEDEL & SCHOEDEL CPAS PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 422 W RIVERSIDE AVE STE 1420 | AddressLine1 |
| City | SPOKANE | City |
| State | WA | State |
| ZIP Code | 992010395 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-08-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201842198 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIU Healthcare NW Health Benefits Trust | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SEIU | NameControl |
| Phone | 4257717359 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 6 | AddressLine1 |
| City | Mukilteo | City |
| State | WA | State |
| ZIP Code | 98275 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Charissa Raynor | Name |
| Title | Executive Director | Title |
| Phone | 2538153728 | Phone |
| Date Signed | 2014-06-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT OPPERUD CPA | Name |
| PTIN | P00542597 | PTIN |
| Phone | 5097472158 | Phone |
| Date Prepared | 2014-05-30 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | David Rolf | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 6 | AddressLine1 |
| City | Mukilteo | City |
| State | WA | State |
| ZIP Code | 98275 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 125875145 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.myseiubenefits.org | WebSite |
| Type Of Organization Trust | X | TypeOfOrganizationTrust |
| Year Formation | 2004 | YearFormation |
| State Legal Domicile | WA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 124546037 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 125854067 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 26497 | InvestmentIncomePriorYear |
| Investment Income Current Year | 21078 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3717 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 124576251 | TotalRevenuePriorYear |
| Total Revenue Current Year | 125875145 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 116158847 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 129225279 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2358374 | OtherExpensePriorYear |
| Other Expenses Current Year | 2722813 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 118517221 | TotalExpensesPriorYear |
| Total Expenses Current Year | 131948092 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6059030 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -6072947 | RevenuesLessExpensesCY |
| Total Assets BOY | 33951255 | TotalAssetsBOY |
| Total Assets EOY | 28254268 | TotalAssetsEOY |
| Total Liabilities BOY | 1556283 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1932243 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 32394972 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 26322025 | NetAssetsOrFundBalancesEOY |
| Mission Description | The Trust provides health and welfare benefits pursuant to collective bargaining agreements between various employers and the Trust. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Description | 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. | Description |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 2 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Benefit Solutions Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4257717359 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12121 Harbour Reach Drive Ste 105 | AddressLine1 |
| City | Mukilteo | City |
| State | WA | State |
| ZIP Code | 98275 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| David Rolf | ||||||
| Chairman / Labor Trustee | 1.00 | X | X | 0 | 0 | 0 |
| 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 | |
| Dan Murphy | ||||||
| Employer Trustee | 1.00 | X | 0 | 0 | 0 | |
| Diane Lutz | ||||||
| Employer Trustee | 1.00 | X | 0 | 0 | 0 | |
| Flanna Perkins | ||||||
| Employer Trustee | 1.00 | X | 0 | 0 | 0 | |
| Charissa Raynor | ||||||
| Executive Director | 10.00 | X | 0 | 124109 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 124109 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SEIU Healthcare NW Training Partnership | |||||
| 215 Columbia Street | Seattle | WA | 98104 | Plan administration | 595073 |
| Benefit Solutions Inc | |||||
| 12121 Harbour Reach Drive Suite 10 | Mukilteo | WA | 98275 | Contract administrator | 587674 |
| Delta Dental of Washington | |||||
| 9706 Fourth Avenue NE | Seattle | WA | 981152157 | Dental claims administrator | 302975 |
| SEIU Healthcare 775NW | |||||
| 33615 1st Way South Suite A | Federal Way | WA | 98003 | Member resource center | 265576 |
| Brown & Brown of WA Inc dba DiMartino | |||||
| 1501 Fourth Avenue Suite 2400 | Seattle | WA | 98101 | Benefits consulting | 165000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Employer contributions | 525100 | 121784016 | 121784016 |
| Participant contributions | 525100 | 4057746 | 4057746 |
| Employer late charges | 525100 | 12305 | 12305 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 125854067 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21078 | TotalRevenueColumn |
| Exclusion | $21,078 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 125875145 | TotalRevenueColumn |
| Related Or Exempt Function Income | 125854067 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $21,078 | ExclusionAmount |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129225279 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1817347 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 130475 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25667 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 231778 | Total |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21857 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131017 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 317073 | Total |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6723 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 649 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10885 | Total |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Dues | Description |
| Total | 29342 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 131948092 | Total |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20833373 | BOY |
| EOY | 13084490 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13094098 | BOY |
| EOY | 15155764 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12594 | BOY |
| EOY | 12230 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11190 | BOY |
| EOY | 1784 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33951255 | BOY |
| EOY | 28254268 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 251283 | BOY |
| EOY | 146743 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1305000 | BOY |
| EOY | 1785500 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1556283 | BOY |
| EOY | 1932243 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32394972 | BOY |
| EOY | 26322025 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32394972 | BOY |
| EOY | 26322025 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33951255 | BOY |
| EOY | 28254268 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -6072947 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Dental claims payable | $420,000 |
| Premiums due to insurers | $1,105,500 |
| Dental claims incurred but not reported | $260,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1785500 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 125875145 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 125875145 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 125875145 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 131948092 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 131948092 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 131948092 | TotalExpensesPerForm990 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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 is the Chairman of this trust, the President of SEIU Healthcare 775NW, and the Chairman of the SEIU Healthcare NW Training Partnership. Misha Werschkul is a trustee of this trust and an employee of SEIU Healthcare 775NW. Seth Hedmond 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. Dan Murphy is a trustee of this trust, a trustee of SEIU Healthcare NW Training Partnership, and an employee of the State of Washington, an employer of record participating in this trust. Eric Erickson is a trustee of this trust and an employee of CDM Services, a participating employer of this trust. Diane Lutz is a trustee of this trust and an employee of the State of Washington, an employer of record participating in this trust. Flanna Perkins is a trustee of this trust, a trustee of SEIU Healthcare NW Training Partnership, and an employee of ResCare Homecare, a participating employer of this trust. 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 | There are four voting Labor Trustees and four voting Employer Trustees. 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 will investigate 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. |
| 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | EINEIN |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Home care services | WA | 501(c)(3) | Line 7 | N/A | 0 | 911156809 |
| 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 | ||||||||||
| 635 Andover Park West Suite 200 | Tukwila | WA | 98188 | To provide comprehensive training, support, and career development benefits. | WA | 501(c)(3) | Line 2 | N/A | 0 | |
| SEIU Healthcare 775NW | ||||||||||
| 33615 First Way S Suite A | Federal Way | WA | 98003 | 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 | |||
| Visiting Nurse HomeCare | ||||||||||
| 600 Birchwood Avenue Suite 100 | Bellingham | WA | 98225 | Home care services | WA | 501(c)(3) | Line 9 | N/A | 0 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (12 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|
| AAA Residential Services | ||||||||
| 16256 Military Rd S Suite 209 | SeaTac | WA | 98188 | Home care services | WA | N/A | C | 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 |
| CDM HomeCare Services | ||||||||
| 11818 S E Mill Plain Blvd | Vancouver | WA | 98684 | Home care services | WA | N/A | C | 0 |
| Chesterfield Services Inc | ||||||||
| 703 Columbia Street Suite 200 | Seattle | WA | 98104 | Home care services | WA | N/A | C | 0 |
| Lower Columbia Community Action Council | ||||||||
| 1526 Commerce Avenue | Longview | WA | 98632 | 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 |
| Whatcom Counseling and Psychiatric Clinic | ||||||||
| 3645 E McLeod Road | Bellingham | WA | 98226 | Home care services | WA | N/A | S | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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