Civic Intelligence

Washington State Rural Hospital Insurance Trust

EIN 30-6135422 • 501(c)9 • Mukilteo, WA

Profile

To provide an entity to which can be paid contributions from participating employers and contributions from participating employees (if applicable) and through which the Trustees can create and administer one or more employee welfare benefit plans for the participating employees and their beneficiaries on whose behalf the contributions have been paid.

PO Box 6Mukilteo, WA 98275

n/A

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2021

Liabilities / Revenue

80th percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)9 • <$500k nonprofits • Source year 2021

Net Margin

2nd percentile

-434476%

Higher net margin than 2% of similar nonprofits.

501(c)9 • <$500k nonprofits • Source year 2021

Top Officer Pay

75th percentile

$0

Higher top officer pay than 75% of similar nonprofits.

Top officer pay equals 0.0% of source-year revenue.

501(c)9 • <$500k nonprofits • Source year 2021

Asset Growth

46th percentile

-100%

Faster asset growth than 46% of similar nonprofits.

501(c)9 • <$500k nonprofits • Annualized from 2020 to 2021

Revenue Growth

12th percentile

-100%

Faster revenue growth than 12% of similar nonprofits.

501(c)9 • <$500k nonprofits • Annualized from 2020 to 2021

Assets

Down

$0

Down $497,151 (-100%) from 2020

Liabilities

Down

$0

Down $10,538 (-100%) from 2020

Net Assets

Down

$0

Down $486,613 (-100%) from 2020

Revenue

Down

$112

Down $4,033,416 (-100%) from 2020

Expenses

Down

$486,725

Down $3,299,001 (-87%) from 2020

Net Income

Down

-$486,613

Down $734,415 (-296%) from 2020

Trend Graphs

Balance Sheet Trend

Grouped bars show assets, liabilities, and net assets across loaded filings.

$1.5M$1.0M$500K$0-$500KAssets 2010: $850,263Liabilities 2010: $11,830Net Assets 2010: $838,4332010Assets 2011: $1,239,958Liabilities 2011: $138,924Net Assets 2011: $1,101,0342011Assets 2012: $977,011Liabilities 2012: $40,786Net Assets 2012: $936,2252012Assets 2013: $1,287,170Liabilities 2013: $92,984Net Assets 2013: $1,194,1862013Assets 2014: $1,360,175Liabilities 2014: $2,316Net Assets 2014: $1,357,8592014Assets 2015: $863,209Liabilities 2015: $7,956Net Assets 2015: $855,2532015Assets 2016: $1,026,188Liabilities 2016: $365,222Net Assets 2016: $660,9662016Assets 2017: $452,019Liabilities 2017: $743,190Net Assets 2017: -$291,1712017Assets 2018: $158,675Liabilities 2018: $291,269Net Assets 2018: -$132,5942018Assets 2019: $240,337Liabilities 2019: $1,526Net Assets 2019: $238,8112019Assets 2020: $497,151Liabilities 2020: $10,538Net Assets 2020: $486,6132020Assets 2021: $0Liabilities 2021: $0Net Assets 2021: $02021

Highlighted filing

2021

Assets$0
Liabilities$0
Net Assets$0

Operations Trend

Revenue, expenses, and net income by year, with the latest filing highlighted.

$6.0M$4.0M$2.0M$0-$2.0MExpenses 2010: $4,769,6272010Expenses 2011: $5,452,0532011Expenses 2012: $5,579,1632012Revenue 2013: $5,140,715Expenses 2013: $4,882,754Net Income 2013: $257,9612013Revenue 2014: $4,582,939Expenses 2014: $4,419,266Net Income 2014: $163,6732014Revenue 2015: $5,211,664Expenses 2015: $5,714,270Net Income 2015: -$502,6062015Revenue 2016: $5,750,682Expenses 2016: $5,944,969Net Income 2016: -$194,2872016Revenue 2017: $4,332,260Expenses 2017: $5,284,397Net Income 2017: -$952,1372017Revenue 2018: $4,817,840Expenses 2018: $4,659,263Net Income 2018: $158,5772018Revenue 2019: $4,649,513Expenses 2019: $4,278,108Net Income 2019: $371,4052019Revenue 2020: $4,033,528Expenses 2020: $3,785,726Net Income 2020: $247,8022020Revenue 2021: $112Expenses 2021: $486,725Net Income 2021: -$486,6132021

Highlighted filing

2021

Revenue$112
Expenses$486,725
Net Income-$486,613

Filings

Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Jan 1, 2021 to Dec 31, 2021
Signed
May 11, 2022
Return Version
2021v4.2
Gross Receipts
$112
Mission and Program Overview

Mission

The Trust was formed to create an entity to accept employer and employee contributions from participating employers to fund one or more employee welfare benefit plans for the participating members and their beneficiaries.

To provide qualified health and welfare benefits to participants.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$106,866$0▼ $106,866
Accounts Receivable$44,926$0▼ $44,926
Cash and Non-Interest-Bearing Accounts-$0-
Other Notes and Loans Receivable, Net-$0-
Pledges and Grants Receivable-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities-$0-
Investments Program Related-$0-
Investments in Publicly Traded Securities-$0-
Land, Buildings, and Equipment, Net-$0-
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Prepaid Expenses and Deferred Charges-$0-
Total Assets$497,151$0▼ $497,151
Other Assets Total$345,359$0▼ $345,359
Liabilities
Accounts Payable and Accrued Expenses$10,538--
Total Liabilities$10,538$0▼ $10,538
Net Assets / Fund Balance
Net Assets With Donor Restrictions$486,613$0▼ $486,613
Total Net Assets Fund Balance$486,613$0▼ $486,613
Total Liabilities and Net Assets / Fund Balance$497,151$0▼ $497,151
Compensation and Service Providers

Board Members and Trustees

NameTitle
Matt EllsworthChairman
Emmett SchusterTrustee
Mo SheldonTrustee
Rachel SlifkaTrustee
Rosalinda KibbyTrustee
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$112
Other Revenue
$0
Change in Net Assets
$-486,613
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$432,371
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Payments to Affiliates---$408,845
Benefits to Members---$54,354
Insurance---$6,320
Fees for Services Legal---$6,206
Fees for Services Accounting---$6,000
Fees for Services Management---$5,000
Total Functional Expenses$0$0$0$486,725
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Backup withholding compliance
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
Yes
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
No
Key decisions subject to board approval
No
Management duties delegated
Yes

Governance Explanations

Form 990, Part VI, Section A, line 3

The Trust contracted with a third-party administrator (Vimly Benefit Solutions, Inc.) to provide bookkeeping and administrative services.

Form 990, Part VI, Section A, line 4

The Trust ceased operations and was dissolved by December 31, 2021.

Form 990, Part VI, Section A, line 7A

The Board of Trustees comprised: a) five representatives of separate participating employer hospitals, as appointed by the Association of Washington Public Hospital Districts (Association); b) the Executive Director of the Association, who serves as Chair of the Board of Trustees (Chairperson), or may appoint a qualified individual to serve as Chairperson in his/her stead. If the appointed individual is not a seated trustee with voting capacity, the Executive Director will retain his/her voting capacity, and the appointed individual will have no authority to vote on any Board action or appoint individuals to either of the non-voting trustee positions described in c) or d) below; c) one appointment by the Chairperson of an individual whose position is Chief Financial Officer of one of the participating employers, who will serve as a non-voting trustee; and d) one appointment by the Chairperson of an individual whose position is Human Resources Manager of one of the participating employers, who will serve as a non-voting trustee.

Form 990, Part VI, Section B, line 11B

The Form 990 was prepared by the independent accounting firm SCHOEDEL & SCHOEDEL, Certified Public Accountants, PLLC. A draft copy of the Trust's Form 990 was 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 and approved for filing by the Board of Trustees.

Form 990, Part VI, Section B, line 12C

All proposed relationships with service providers were reviewed by Trust counsel for compliance with prohibited transactions. All agreements between the Trust and service providers authorized to conduct transactions on behalf of the Trust were provided to Trust counsel for review before execution to ensure that, wherever possible, the agreement contains appropriate restrictions or other protections against prohibited transactions with parties in interest. In addition, all interested persons were required to disclose any actual or possible conflict of interest as soon as it became known or should have become known. An interested person is defined as any member of the Board of Trustees or other individual or organization which is delegated with fiduciary responsibility for the assets of the Trust, who has a direct or indirect financial interest, other than being a participant in the Trust. An interested person may have made a presentation at the meeting of the Board of Trustees, but after the presentation, he/she was required to leave the meeting while the remaining Trustees deliberated and voted on the matter. The Chairperson of the Board of Trustees, if appropriate, appointed a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the Board of Trustees determined whether the Trustees was able to obtain with reasonable efforts a more advantageous transaction or arrangement from a person or entity that would not have given rise to a conflict of interest. If a more advantageous transaction or arrangement was not reasonably possible under circumstances not producing a conflict of interest, the Board of Trustees determined by majority vote of the disinterested Trustees whether the transaction or arrangement was in the Trust's best interests, for its benefit, and whether it was fair and reasonable. In conformity with the above determination, it made its decision as to whether to enter into the transaction or arrangement. The minutes of the meetings of the Board of Trustees and all committee meetings contain: 1) the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the Trustees' decision as to whether a conflict of interest existed; and 2) the names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussions, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection with the proceedings.

Form 990, Part VI, Section B, line 15

There were no compensated management officials, officers or key employees of the organization. If the organization had such compensated individuals, policies and procedures would have been developed to determine compensation.

Form 990, Part VI, Section C, line 19

The Trust's governing documents, conflict of interest policy, and Form 990 are available to the general public upon written request sent to the Trust in care of Vimly Benefit Solutions, Inc. at: P.O. Box 6; Mukilteo, WA 98275.

Form 990, Part VII, Section A, Line 1A:

The Trust did not compensate any of the members of the Board of Trustees. One Trustee was the Executive Director of the Association of Washington Public Hospital Districts (the Association), the sponsor of the Trust. The other Trustees were administrators, chief executive officers, chief financial officers, chief operations officers, or other senior executives of participating employer hospitals. The Executive Director of the sponsor understood that, as part of his employment expectations for the Association, he must serve as the Trust's Chairperson of the Board. His regular compensation from the Association took into consideration services performed by him in regard to the Trust. The remaining Trustees served on a volunteer basis, and received no known compensation from their employers or any other party for their services on the Board. The Trust did not readily have access to information related to compensation paid by other entities to the Trustees.

Filing and Contact Details

Filer

Filer Name
Washington State Rural Hospital
EIN
30-6135422
Phone
4257717359
Address
PO Box 6, Mukilteo, WA 98275

Signing Officer

Name
Matt Ellsworth
Title
Chair
Phone
4257717359
Signed
2022-05-11
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Matt Ellsworth
Formed
2006
Legal Domicile
Wa
Voting Board Members
5
Independent Board Members
5
Employees
0
Volunteers
0

Preparer

Firm
Schoedel & Schoedel Cpas Pllc
Address
422 W RIVERSIDE AVE STE 1420, SPOKANE, WA 99201-0395
Preparer
Scott Opperud CPA
Phone
5097472158
Supplemental Narrative

Additional Explanations

Form 990, Part III, line 3

The Trust ceased operations and was dissolved by December 31, 2021.

Raw XML Appendix385 raw XML fields

This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/AddressLine1Txt1200 Nat Washington Way
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/AddressLine1Txt29801 Frontier Ave SE
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/CityNm0Odessa
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/CityNm1Ephrata
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/CityNm2Snoqualmie
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/StateAbbreviationCd0WA
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/StateAbbreviationCd1WA
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/StateAbbreviationCd2WA
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IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/ZIPCd1988231982
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/ZIPCd2980655200
IRS990ScheduleN/OwnerOfSuccessorInd00
IRS990ScheduleN/ReceiveCompensationInd00
IRS990ScheduleN/RequiredToNotifyAGInd00
IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt0Person(s) Involved: Members of the Board of Trustees
IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt1Explanation of Involvement: The tranferee organizations, which were participating hospitals in the trust, were represented by employees who served on the Board of Trustees of the trust. That employment status is expected to continue.
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc0Part I, Line 2e:
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc1Part I, Line 2e:
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0The Trust ceased operations and was dissolved by December 31, 2021.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1The Trust contracted with a third-party administrator (Vimly Benefit Solutions, Inc.) to provide bookkeeping and administrative services.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2The Trust ceased operations and was dissolved by December 31, 2021.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3The Board of Trustees comprised: a) five representatives of separate participating employer hospitals, as appointed by the Association of Washington Public Hospital Districts (Association); b) the Executive Director of the Association, who serves as Chair of the Board of Trustees (Chairperson), or may appoint a qualified individual to serve as Chairperson in his/her stead. If the appointed individual is not a seated trustee with voting capacity, the Executive Director will retain his/her voting capacity, and the appointed individual will have no authority to vote on any Board action or appoint individuals to either of the non-voting trustee positions described in c) or d) below; c) one appointment by the Chairperson of an individual whose position is Chief Financial Officer of one of the participating employers, who will serve as a non-voting trustee; and d) one appointment by the Chairperson of an individual whose position is Human Resources Manager of one of the participating employers, who will serve as a non-voting trustee.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4The Form 990 was prepared by the independent accounting firm SCHOEDEL & SCHOEDEL, Certified Public Accountants, PLLC. A draft copy of the Trust's Form 990 was 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 and approved for filing by the Board of Trustees.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5All proposed relationships with service providers were reviewed by Trust counsel for compliance with prohibited transactions. All agreements between the Trust and service providers authorized to conduct transactions on behalf of the Trust were provided to Trust counsel for review before execution to ensure that, wherever possible, the agreement contains appropriate restrictions or other protections against prohibited transactions with parties in interest. In addition, all interested persons were required to disclose any actual or possible conflict of interest as soon as it became known or should have become known. An interested person is defined as any member of the Board of Trustees or other individual or organization which is delegated with fiduciary responsibility for the assets of the Trust, who has a direct or indirect financial interest, other than being a participant in the Trust. An interested person may have made a presentation at the meeting of the Board of Trustees, but after the presentation, he/she was required to leave the meeting while the remaining Trustees deliberated and voted on the matter. The Chairperson of the Board of Trustees, if appropriate, appointed a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the Board of Trustees determined whether the Trustees was able to obtain with reasonable efforts a more advantageous transaction or arrangement from a person or entity that would not have given rise to a conflict of interest. If a more advantageous transaction or arrangement was not reasonably possible under circumstances not producing a conflict of interest, the Board of Trustees determined by majority vote of the disinterested Trustees whether the transaction or arrangement was in the Trust's best interests, for its benefit, and whether it was fair and reasonable. In conformity with the above determination, it made its decision as to whether to enter into the transaction or arrangement. The minutes of the meetings of the Board of Trustees and all committee meetings contain: 1) the names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the Trustees' decision as to whether a conflict of interest existed; and 2) the names of the persons who were present for discussions and votes relating to the transaction or arrangement, the content of the discussions, including any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection with the proceedings.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6There were no compensated management officials, officers or key employees of the organization. If the organization had such compensated individuals, policies and procedures would have been developed to determine compensation.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7The Trust's governing documents, conflict of interest policy, and Form 990 are available to the general public upon written request sent to the Trust in care of Vimly Benefit Solutions, Inc. at: P.O. Box 6; Mukilteo, WA 98275.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8The Trust did not compensate any of the members of the Board of Trustees. One Trustee was the Executive Director of the Association of Washington Public Hospital Districts (the Association), the sponsor of the Trust. The other Trustees were administrators, chief executive officers, chief financial officers, chief operations officers, or other senior executives of participating employer hospitals. The Executive Director of the sponsor understood that, as part of his employment expectations for the Association, he must serve as the Trust's Chairperson of the Board. His regular compensation from the Association took into consideration services performed by him in regard to the Trust. The remaining Trustees served on a volunteer basis, and received no known compensation from their employers or any other party for their services on the Board. The Trust did not readily have access to information related to compensation paid by other entities to the Trustees.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0Form 990, Part III, line 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1Form 990, Part VI, Section A, line 3
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2Form 990, Part VI, Section A, line 4
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3Form 990, Part VI, Section A, line 7a
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4Form 990, Part VI, Section B, line 11b
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5Form 990, Part VI, Section B, line 12c
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6Form 990, Part VI, Section B, line 15
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7Form 990, Part VI, Section C, line 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8Form 990, Part VII, Section A, Line 1A:
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0To provide healthcare services for patients
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt1To provide healthcare services for patients
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt09801 Frontier Ave SE
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt1200 Nat Washington Way
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt2502 E Amende Drive
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm0Snoqualmie
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm1Ephrata
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/CityNm2Odessa
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ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/AuthenticationAssuranceLevelCd0AAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/IdentityAssuranceLevelCd0IAL1
ReturnHeader/AdditionalFilerInformation/TrustedCustomerGrp/TrustedCustomerCd03
ReturnHeader/BuildTS02022-09-23 18:48:47Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd01
ReturnHeader/BusinessOfficerGrp/PersonNm0Matt Ellsworth
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0Chair
ReturnHeader/BusinessOfficerGrp/PhoneNum04257717359
ReturnHeader/BusinessOfficerGrp/SignatureDt02022-05-11
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0Washington State Rural Hospital
ReturnHeader/Filer/BusinessName/BusinessNameLine2Txt0Insurance Trust
ReturnHeader/Filer/BusinessNameControlTxt0WASH
ReturnHeader/Filer/EIN0306135422
ReturnHeader/Filer/PhoneNum04257717359
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ReturnHeader/PreparerFirmGrp/PreparerFirmName/BusinessNameLine1Txt0SCHOEDEL & SCHOEDEL CPAS PLLC
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/AddressLine1Txt0422 W RIVERSIDE AVE STE 1420
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ReturnHeader/PreparerFirmGrp/PreparerUSAddress/StateAbbreviationCd0WA
ReturnHeader/PreparerFirmGrp/PreparerUSAddress/ZIPCd0992010395
ReturnHeader/PreparerPersonGrp/PhoneNum05097472158
ReturnHeader/PreparerPersonGrp/PreparationDt02022-05-08
ReturnHeader/PreparerPersonGrp/PreparerPersonNm0SCOTT OPPERUD CPA
ReturnHeader/ReturnTs02022-05-11T11:18:52-05:00
ReturnHeader/ReturnTypeCd0990
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonFirstNm0Matt
ReturnHeader/SigningOfficerGrp/PersonFullName/PersonLastNm0Ellsworth
ReturnHeader/TaxPeriodBeginDt02021-01-01
ReturnHeader/TaxPeriodEndDt02021-12-31
ReturnHeader/TaxYr02021

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