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TIN:
SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is atwww.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Inspection
Name of the organization
SEIU Healthcare NW Health Benefits Trust
Employer identification number
20-1842198
20-1842198
| Return Reference | Explanation |
|---|---|
| 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. Mark Robinson is a trustee of this trust and an employee of Addus Healthcare, Inc., an employer of record participating in this trust. Seth Hemond is a trustee of this trust, an employee of SEIU Healthcare 775NW, and a trustee of the SEIU Healthcare NW Training Partnership. MaryAnne Lindeblad is a trustee of this trust, and an employee of State of WA, an employer of record participating in this trust. 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, an employee and the Secretary-Treasurer of SEIU Healthcare 775NW. 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. Bill Moss is a trustee of this trust, a trustee of SEIU Healthcare NW Training Partnership, and an employee of State of Washington an employer of record participating in this trust. 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 | 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. |
| 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 eleven individuals, five 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. Additionally, the amount of time spent on activities related to being a Trustee is less than 300 hours per year per Trustee. |
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013
Additional Data
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