IBEW WESTERN UTILITIES HEALTH AND WELFARE TRUST FUND: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
IBEW WESTERN UTILITIES HEALTH AND WELFARE TRUST FUND (EIN 87-0496328)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-07-15
IRS object ID
201301969349300140
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

FieldValueIRS element (for citing)
Timestamp2013-07-15T11:04:38-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN840676265EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SSA PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line13355 American DriveAddressLine1
CityColorado SpringsCity
StateCOState
ZIP Code809175707ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN870496328EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1IBEWWestern Utilities HealthBusinessNameLine1
Business Name Line2and Welfare Trust FundBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlUTAHNameControl
Phone9252089999Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line17180 Koll Center Parkway 200AddressLine1
CityPleasantonCity
StateCAState
ZIP Code94566ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJulie LewisName
TitleChairpersonTitle
Phone5038135048Phone
Date Signed2013-07-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWilliam C Sanden CPAName
PTINP00013248PTIN
Phone7195740100Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJulie LewisNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1825 E MultnomahAddressLine1
CityPortlandCity
StateORState
ZIP Code97232ZIPCode
FieldValueIRS element (for citing)
Gross Receipts39013289GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Siten/aWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1991YearFormation
State Legal DomicileUTStateLegalDomicile
Activity Or Mission DescriptionProvide medical, dental and life insurance benefitsActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year34204921ProgramServiceRevenuePriorYear
Program Service Revenue CY35270745ProgramServiceRevenueCY
Investment Income Prior Year327760InvestmentIncomePriorYear
Investment Income Current Year352349InvestmentIncomeCurrentYear
Other Revenue Prior Year3083OtherRevenuePriorYear
Other Revenue Current Year131OtherRevenueCurrentYear
Total Revenue Prior Year34535764TotalRevenuePriorYear
Total Revenue Current Year35623225TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year31093449BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY32842288BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1734813OtherExpensePriorYear
Other Expenses Current Year1672067OtherExpensesCurrentYear
Total Expenses Prior Year32828262TotalExpensesPriorYear
Total Expenses Current Year34514355TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1707502RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1108870RevenuesLessExpensesCY
Total Assets BOY12963403TotalAssetsBOY
Total Assets EOY15392127TotalAssetsEOY
Total Liabilities BOY6319618TotalLiabilitiesBOY
Total Liabilities EOY7508408TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6643785NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7883719NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide medical, dental and life insurance benefits to participants of the Plan.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense33441034Expense
DescriptionThe Plan provides medical, dental and life insurance benefits under a collectively bargained agreement between IBEW Local Union 57 and PacifiCorp dba Rocky Mountain Power.Description
Total Program Service Expense33441034TotalProgramServiceExpense
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961357NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement0RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BenesysBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9252089999TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line17180 Koll Center Parkway 200AddressLine1
CityPleasantonCity
StateCAState
ZIP Code94566ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Brent Donohue
Trustee2.00X000
Calvin Ockey
Trustee2.00X000
Gary Cox
Trustee2.00X000
Julie Lewis
Chairperson2.00X000
Erich Wilson
Trustee2.00X000
Travis Eri
Secretary2.00X000
Paul Radakovich
Trustee2.00X000
Jeremy Courval
Trustee2.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Contributions Medical5241143385399833853998
Contributions Life52411313161551316155
Self Pay Cobra Medical5241149068990689
Flex Forfeitures52411499039903
FieldValueIRS element (for citing)
Total Program Service Revenue35270745TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column273823TotalRevenueColumn
Exclusion$273,823ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3468590Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3390064Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities78526Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column78526TotalRevenueColumn
Related Or Exempt Function Income78526RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOtherDescription
Business Code900099BusinessCode
Total Revenue Column131TotalRevenueColumn
Related Or Exempt Function Income131RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue131TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column35623225TotalRevenueColumn
Related Or Exempt Function Income35349402RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$273,823ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total32842288Total
Program Services32842288ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total30730Total
Management And General30730ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total29065Total
Management And General29065ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total3518Total
Management And General3518ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total9262Total
Management And General9262ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
Administrative Fees - C548983548983
Consultant Fee - Segal254587254587
PPO Fees - Cigna185600185600
PPO Fee - Wise113357113357

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total496965Total
Program Services299789ProgramServices
Management And General197176ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total34514355Total
Program Services33441034ProgramServices
Management And General1073321ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1090637BOY
EOY1986165EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY908721BOY
EOY1600378EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY604631BOY
EOY435897EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY17783BOY
EOY26874EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY10341631BOY
EOY11342813EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12963403BOY
EOY15392127EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY185143BOY
EOY473282EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6134475BOY
EOY7035126EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6319618BOY
EOY7508408EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6643785BOY
EOY7883719EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6643785BOY
EOY7883719EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12963403BOY
EOY15392127EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses1108870ReconcilationRevenueExpenses
Reconciliation Unrealized Invest131064ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Claims Incurred Not Reported$6,365,000
Claims Payable$670,126
FieldValueIRS element (for citing)
Total Of Amounts7035126TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt35660480TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments131064NetUnrealizedGainsInvestments
Revenue Not Rptd F990131064RevenueNotRptdF990
Revenue Subtotal35529416RevenueSubtotal
Investment Expenses Not Included93809InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt93809RevenueNotRptdOnFinStmt
Total Revenue Per Form99035623225TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt33519896TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal33519896ExpensesSubtotal
Investment Expenses Not Included293809InvestmentExpensesNotIncluded2
Other Expenses Not Included900650OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt994459ExpensesNotRptdOnFinStmt
Total Expenses Per Form99034514355TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X, Line 2:The Plan has adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740, Accounting for Uncertainty in Income Taxes, which prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return and also provides guidance on various related matters such as derecognition, interest, penalties and disclosures required. The Plans determination as a tax-exempt entity is considered a tax position subject to the requirements of ASC 740. There were no unrecognized tax benefits at December 31, 2012, and the Plan does not believe it is reasonably possible that unrecognized tax benefits related to this tax position will significantly change within twelve months of the reporting date. The Plan would recognize interest and penalties, if any, related to unrecognized tax benefits as income tax expense. The Plan did not have any accrued liabilities or expense for interest or penalties related to unrecognized tax benefits for the years ended December 31, 2011 and 2010.
Part XII, Line 4b - Other Adjustments:Claims Incurred Not Reported $1649000 Claims Payable and Flex Spending Adjustment $-748350

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Section B, line 11The Form 990 is reviewed at the Board of Trustees meeting prior to filing the return. All board members have the opportunity to ask questions. The board chairman signs the return at the conclusion of the discussion and is responsible for mailing the return.
Form 990, Part VI, Section C, line 19The documents and financial statements are available upon request by any interested party.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1PacificorpIBEW Local 57 Retirement Trust FundBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1825 NE MultnomahAddressLine1
CityPortlandCity
StateORState
ZIP Code97232ZIPCode
FieldValueIRS element (for citing)
EIN870640888EIN
Primary ActivitiesProvide retirement benefits to participantsPrimaryActivities
Legal Domicile StateORLegalDomicileState
Exempt Code Section501(c)9ExemptCodeSection
Controlled Org0ControlledOrg

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PacifiCorpBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1825 NE MultnomahAddressLine1
CityPortlandCity
StateORState
ZIP Code97232ZIPCode
FieldValueIRS element (for citing)
EIN870023145EIN
Primary ActivityUtility/constructionPrimaryActivity
Legal Domicile StateORLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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