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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 990-EZ 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
2014
Open to Public
Inspection
Inspection
Name of the organization
Local 191 IBEW Health and Welfare Trust
Employer identification number
91-6037488
91-6037488
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 2 | Three of the trustees are employees of IBEW Local 191. |
| Form 990, Part VI, Section A, line 3 | Through March 31, 2016, the Trust contracted with a third-party administrator (Benefit Solutions, Inc.) to provide bookkeeping and administrative services and with two claims administrators (Regence BlueShield and Vision Service Plan) to provide claims adjudication and payment services. |
| Form 990, Part VI, Section A, line 4 | The IBEW Local 191 Health and Welfare Plan Plan Booklet and Summary Plan Description for Medical and Prescription Drug Benefits, as well as the IBEW Local 191 Health and Welfare Plan Plan Booklet and Summary Plan Description for Benefits Other Than Medical and Prescription Drug Benefits, were reprinted, with an effective date of July 1, 2015. |
| Form 990, Part VI, Section A, line 7a | The Trust is administered by a six-member Board of Trustees, three of whom are representatives of the employers (Employer Trustees) and three of whom are representatives of the union (union trustees). Individual trustee positions are selected as described below. Appointment of Successor Employer Trustees: In the event of the termination of appointment, resignation, or death of an Employer Trustee, a successor Employer Trustee is appointed by the Cascade Chapter of the National Electrical Contractors Association. If the Cascade Chapter of the National Electrical Contractors Association declines to appoint a successor Trustee, the remaining Trustees will provisionally appoint a successor Trustee. Notice of the provisional appointment is mailed by the administrative agent to all employers and will become final 30 days after such notice unless, in the meantime, employers representing 51% of participants should object, in writing, to the appointment. In the event such an objection is filed, or in the event the remaining Trustees are unable to make a provisional appointment, the Trustees will conduct a referendum election among all of the employers. Each employer may submit the name of one nominee, and in the referendum each employer will be entitled to one vote. Each vote will be weighted, however, by the number of employees for whom each employer is then making contributions (as measured by the number of employees reported on the employer's contribution reporting form received by the Trust in the month prior to the month of election). The nominee who receives the largest number of votes will be declared the new Employer Trustee. The Trustees will have full authority to make the arrangements for the election, including the adoption of any election rules which they deem appropriate. The costs of the election will be payable by the Trust. Appointment of Successor Union Trustees: In the event of the termination of appointment, resignation, or death of a Union Trustee, a successor Union Trustee is appointed by Local Union Number 191, International Brotherhood of Electrical Workers (Local 191), according to its internal rules, procedures, or practices. The appointment will be confirmed in a written notice from Local 191 sent to the Chairman and Secretary of the Board of Trustees. Each Trustee will consent to and accept his/her appointment as a Trustee in writing. |
| Form 990, Part VI, Section A, line 8b | The Trust has no committees with authority to act on behalf of the governing body. |
| 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 | The Trust distributes a conflict of interest questionnaire annually to all plan fiduciaries. Each plan fiduciary completes the questionnaire and returns it to the Trust. The completed questionnaires are reviewed at a trust meeting. Any identified conflicts of interest or potential conflicts of interest are addressed as deemed necessary by the Board of Trustees. The completed questionnaires are maintained as part of the Trust's records. |
| 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 public upon written request sent to BeneSys Administrators at: P.O. Box 58810; Tukwila, WA 98138. |
| Form 990, Part VII, Section A, Line 1A: | The Trust does not compensate any of the members of the Board of Trustees. The Board is comprised of six individuals, three of all of whom are representatives of the employers and three 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 500 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) 2014
Additional Data
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