2024-08-09T11:46:10-05:00 2023-09-30 911301672 SWEENEY CONRAD PS 10210 NE POINTS DRIVE SUITE 300 KIRKLAND WA 98033 990 2022-10-01 814004703 CENTER FOR ADVANCED MANUFACTURING PUGET SOUND HEALTH TRUST CENT 4256417762 15375 SE 30TH PL SUITE 380 BELLEVUE WA 98007 KIRK DAVIS EXECUTIVE DIRECTOR, TRUSTEE 4256417762 2024-08-08 1 1 WENDE WADSWORTH P00848212 4256291990 2024-06-24 2022 2024-08-08 14:25:15Z KIRK DAVIS 15375 SE 30TH PL SUITE 380 BELLEVUE WA 98007 19185302 0 X N/A X 2016 WA TO PROVIDE HEALTH AND OTHER BENEFITS FOR ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. 3 0 0 3 0 0 0 0 19056281 19167585 197 17717 0 0 19056478 19185302 0 0 18539091 17443268 0 0 0 0 0 510425 486373 19049516 17929641 6962 1255661 2519083 2734699 1718746 678701 800337 2055998 TO PROVIDE HEALTH AND OTHER BENEFITS FOR ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. 0 0 17929641 THE PLAN PROVIDES HEALTH AND OTHER BENEFITS FOR ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS ACCORDING TO THE PROVISIONS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA) 17929641 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 X EPK & ASSOCIATES INC 4256417762 15375 SE 30TH PLACE SUITE 380 BELLEVUE WA 98007 X KIRK DAVIS EXECUTIVE DIRECTOR, TRUSTEE 1.00 40.00 X X 0 185775 22607 SINA VAN SCOYOC TRUSTEE 1.00 40.00 X 0 0 0 DEANNA HELLAND TRUSTEE 1.00 40.00 X 0 0 0 0 185775 22607 0 0 1 0 EPK & ASSOCIATES INC 15375 SE 30TH PLACE 380 BELLEVUE WA 98007 ADMINISTRATIVE SERVICE PROVIDER 452777 1 CONTRIBUTIONS 900099 18965159 18965159 COBRA CONTRIBUTIONS 900099 202426 202426 19167585 17717 17717 19185302 19167585 0 17717 17443268 17443268 401331 401331 24000 24000 15500 15500 39350 39350 6163 6163 BANK FEES 29 29 17929641 17929641 0 0 2513191 250000 0 2392256 5892 92443 2519083 2734699 876911 0 841835 678701 1718746 678701 X 0 0 0 0 800337 2055998 800337 2055998 2519083 2734699 1255661 0 X 0 1 X 1 0 0 PREMIUM PAYABLE 678701 678701 X 19185302 0 19185302 0 19185302 18092775 0 18092775 -163134 -163134 17929641 PART X, LINE 2: THE PLAN RECEIVED A FAVORABLE DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) DATED APRIL 13, 2022, STATING THAT THE PLAN IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). THE BOARD OF TRUSTEES BELIEVES THAT THE PLAN IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. THEY BELIEVE THAT THE PLAN WAS TAX-EXEMPT AS OF THE FINANCIAL-STATEMENT DATE; THEREFORE, NO PROVISION FOR INCOME TAX HAS BEEN INCLUDED IN THE PLAN'S FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF THE LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICITIONS, AND THE PLAN COULD BE SUBJECT TO INCOME TAX IF CERTAIN ISSUES WERE FOUND BY THE IRS THAT COULD RESULT IN THE DISQUALIFICATION OF THE PLAN'S TAX-EXEMPT STATUS; HOWEVER, THERE ARE CURRENLTY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN PREMIUM PAYABLE -163,134. 0 0 0 KIRK DAVIS EXECUTIVE DIRECTOR, TRUSTEE 0 185775 0 0 0 0 0 9403 0 13204 0 208382 0 0 FORM 990, PART VI, SECTION A, LINE 3 DAY TO DAY OPERATIONS OF THE TRUST ARE DELEGATED TO A THIRD-PARTY ADMINISTRATOR, EPK & ASSOCIATES, INC. THE BOARD RETAINS ULTIMATE RESPONSIBILITY FOR THE OPERATION OF THE TRUST. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT IS REVIEWED AND APPROVED BY THE SIGNING TRUSTEE AND THIRD-PARTY ADMINISTRATOR BEFORE FILING. FORM 990, PART VI, SECTION C, LINE 19 NO OTHER DOCUMENTS ARE AVAILABLE TO THE PUBLIC. FORM 990, SECTION A, LINE 1A: TRUSTEES ARE NOT COMPENSATED BY THE FILING ORGANIZATION. CERTAIN TRUSTEES ARE EMPLOYED BY FOR-PROFIT CONTRIBUTING EMPLOYERS, WHICH ARE DEFINED AS RELATED PARTIES IN THE INSTRUCTIONS TO SCHEDULE R. PER THE VOLUNTEER EXCEPTION IN THE INSTRUCTIONS TO FORM 990, THIS COMPENSATION IS NOT REPORTABLE IN PART VII OF FORM 990 AS RELATED-ORGANIZATION COMPENSATION. 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