2012-05-14T15:51:35-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 3000 NORTHUP WAY SUITE 200 BELLEVUE WA 980041446 990 2010-07-01 916068079 NORTHWEST IRONWORKERS HEALTH & SECURITY TRUST NORT 2064417574 PO BOX 34203 SEATTLE WA 98124 ESCOTT DAHLGREN 2064417574 2012-05-10 1 KENNETH L CLENIN CPA 4252506100 2010 2016-02-24 21:20:13Z ESCOTT DAHLGREN PO BOX 34203 SEATTLE WA 98124 68186452 0 X N/A X 1966 WA HEALTH BENEFITS FOR PARTICIPANTS 16 16 43 16 0 0 0 0 24566247 25358888 1828758 1509042 0 3266 26395005 26871196 0 0 29368047 27676983 14599 12008 0 0 0 2595453 2567810 31978099 30256801 -5583094 -3385605 50436055 49464804 18422945 18587742 32013110 30877062 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS OF THE PLAN. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS OF THE PLAN. 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1469 0 1 43 1 0 0 0 0 0 0 0 0 X 16 16 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X WELFARE & PENSION ADMIN SERVICE INC 2064417574 2815 SECOND AVE SEATTLE WA 98121 X ESCOTT DAHLGREN 1.00 X X 0 0 0 RON PIKSA 1.00 X X 0 0 0 DENNIS CAREY 1.00 X 0 0 0 REX SMITH 1.00 X 0 0 0 DONNIE PATTERSON 1.00 X 0 0 0 JOHN HIGHTOWER 1.00 X 0 0 0 GREG KUCERA 1.00 X 0 0 0 STEVEN LARUE 1.00 X 0 0 0 STEVE PENDERGRASS 1.00 X 0 0 0 JEFF ILENSTINE 1.00 X 0 0 0 DAVE HARRISON 1.00 X 0 0 0 KEVIN JENSEN 1.00 X 0 0 0 BRIAN J O'NEILL 1.00 X 0 0 0 JAMES PAULEY 1.00 X 0 0 0 JEFF GLOCKNER 1.00 X 0 0 0 RAYMOND TANNER 1.00 X 0 0 0 BOB CLERIHEW 1.00 X 0 0 0 DAVE CHASE 1.00 X 0 0 0 RICK MORTON 1.00 X 0 0 0 0 0 0 0 0 0 0 WELFARE AND PENSION ADMINISTRATION SERVI 2815 2ND AVENUE STE 300 SEATTLE WA 98124 ADMINISTRATION AND CLAIMS PROCESSING FEE 758547 PREMERA BLUE CROSS 7001 220ST SW BUILDING 1 MOUNTLAKE TERRACE WA 98043 CLAIMS PROCESSING FEES 750997 QUALIS HEALTH PO BOX 33400 SEATTLE WA 98133 CASE MANAGEMENT 154867 THE SEGAL COMPANY 100 MONTGOMERY STREET STE 500 SAN FRANCISCO CA 94104 CONSULTING AND ACTUARIAL FEES 115286 4 EMPLOYER CONTRIBUTIONS 525100 18827826 18827826 SELF PAYS 525100 5763839 5763839 COBRA REIMBURSEMENT 525100 454275 454275 FORMULARY REBATE 525100 279173 279173 LIQUIDATED DAMAGES 525100 22827 22827 10948 10948 25358888 1289216 1289216 41535082 41315256 219826 219826 219826 REFUNDS 525100 3266 3266 3266 26871196 25358888 0 1512308 27676983 12008 260180 81245 48680 108616 115286 113593 23143 14340 68106 CLAIMS PROCESSING FEE 1329255 CASE MANAGEMENT FEE 170344 DRUG TEST PROGRAM EXPEN 146170 EMPLOYEE ASSISTANCE PRO 49369 COLLECTION COORDINATOR 39483 30256801 154583 466854 1668749 696455 2294779 702453 0 0 1747793 2020187 20249 19064 16719 8272 16719 41580402 41346376 2961228 4196696 50436055 49464804 9980787 8897831 8442158 9689911 18422945 18587742 X 0 0 0 0 32013110 30877062 32013110 30877062 50436055 49464804 X -3385605 2249557 X X 0 1 1 X 0 16719 16719 16719 SHORT TERM INV UNDER SEC LENDING AGREEMENT 4196696 F 4196696 ESTIMATED ACCUMULATED ELIGIBILITY CREDITS 5192000 OBLIGATION UNDER SECURITY LENDING AGREEMENT 4497911 9689911 26871196 30256801 -3385605 2249557 2249557 -1136048 29012137 2249557 2249557 26762580 108616 108616 26871196 31243733 0 31243733 108616 -1095548 -986932 30256801 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF JUNE 30, 2011 AND 2010, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2007. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN PREMIUMS PAYABLE 101,452. CHANGE IN CLAIMS PAYABLE -446,000. CHNAGE IN INCURRED BUT NOT REPORTED CLAIMS -715,000. CHANGE IN ACCUMULATED ELIGIBILITY CREDITS -36,000. FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY OPERATIONS OF THE PLAN ARE MANAGED BY WELFARE & PENSION ADMINISTRATION SERVICE, A THIRD PARTY ADMINISTRATOR. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE 990 IS PROVIDED TO THE PLAN'S THIRD PARTY ADMINISTRATOR FOR POSTING ON THE PLAN'S TRUSTEE WEBSITE. THE PLAN'S ATTORNEY ALSO REVIEWS THE 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE PLAN'S THIRD PARTY ADMINISTRATOR SENDS AN ANNUAL QUESTIONNAIRE TO EACH TRUSTEE REGARDING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT IN INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO PARTICIPANTS UPON REQUEST OF THE PLAN'S THIRD PARTY ADMINISTRATOR. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,249,557. FORM 990, PART XI, LINE 2C THE PLAN'S FULL BOARD OF TRUSTEES SELECTS INDEPENDENT AUDITORS AND OVERSEES THE ANNUAL AUDIT. IRONWORKERS DIST COUNCIL OF THE PACIFIC NW FIELD IRONWORKERS ANNUITY TR FD PO BOX 34203 SEATTLE WA 98124 911342114 TO PROVIDE RETIREMENT BENEFITS TO PARTICIPANTS WA 501(A) 0 NORTHWEST IRONWORKERS RETIREMENT TRUST PO BOX 34203 SEATTLE WA 98124 916123688 TO PROVIDE RETIREMENT BENEFITS TO PARTICIPANTS WA 501(A) 0 NORTHWEST IRONWORKERS - EMPLOYERS VACATION PLAN PO BOX 34203 SEATTLE WA 98124 516029816 TO PROVIDE VACATION BENEFITS TO PARTICIPANTS WA 501(C)(9) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0