Return of Organization ExemptFromIncomeTax990s.foundationcenter.org/990_pdf_archive/911/... · r • 990 OMBNo 1545-0047 Form Return of Organization ExemptFromIncomeTax Undersection

r • 990 OMB No 1545-0047

Form Return of Organization Exempt From Income Tax2009Under section 501 (c), 527, or 4947(aXl) of the Internal Revenue Code

(except black lung benefit trust or private foundation)

Internal Revenue Servceury ► The organization may have to use a copy of this return to satisfy state reporting requirements Open to Public Inspection

For the 2009 calendar year, or tax year beg innin g , 2009 , and endin g

B Check if applicable C Name of organization D Employer Identification Number

Address changePlease useIRS label District 1199 NW , Hospital & Health Care Emp. Union , SEIU , AFL-CIO 91-1275780

Name changeor P not

.or type Number and street (or P 0 box if mail is not delivered to street addr) Room/suite E Telephone number

Initial return spei'fic 15 South Grady Way 200 (425) 917-1199

Termination Lionsons

IniCity, town or country State ZIP code + 4

Amended return Renton WA 98057 G Gross receipts $ 12 , 101, 586 .

Application pending F Name and address of princ i pal off i cer H(a) Is this a group return for aff l ates' Yes

FNChris Barton 15 South Grady Wa Renton WA 98057H(b) Are all affiliates included? Yes

If 'No,' attach a list (see instructions) 11

Tax-exem p t status X 501 c 5 ' (Insert no) 4947(a 1) or 527I

J Website : ► SEIU119 9NW . or H(c ) Group exemption number

K Form of organization X Corporation Trust Association Other L Year of Formation 1985 M State of legal domicile WA

Part I Summa ry

1 Briefly describe the organization's mission or most significant activities Washington al_hethcare union _ _ _

_whi_c_h_r_eyresents and_advoc ates for registered_ nurses,_ licensed practical-nurses,

technolojcists , mental health clinicians , professionals , therapist ,_certified nursing------ ------------------- ------ ---- -----------

E aids and other kinds of health care workers.- --

.-more--than--

25%-of-its assets-2 Check this box ► if t-he-or-aa-nlzatlon dlscontlnued its ooeratlons or dlsoosed-of-

3 Number of voting members of the governing body (Part VI, line 1 a) 3 924 Number of independent voting members of the governing body (Part VI, line 1b) 4 92

•'= 5 Total number of employees (Part V, line 2a) 5 1406 Total number of volunteers (estimate if necessary) 6 0

a 7a Total gross unrelated business revenue from Part VIII, (column (C), Ine 12 7a 0.

b Net unrelated business taxable income from Form 990-T, line 34 7b

Prior Year Current Year

8 Contributions and grants (Part VIII, line 1h) 11, 057, 405 . 11, 965, 258.

9 Program service revenue (Part VIII, line 2g) 19,683. 121, 739.

10 Investment Income (Part VIII, column (A), line , 4, R CEI® 9,843.

[11 Other revenue (Part VIII, column (A), lines 5,

QQ^

5d 4,746.12 Total revenue - add lines 8 throug h 11 (must I P rt Vlll column (A), II 11, 077, 088. 12 , 101, 586.

13 Grants and similar amounts paid (Part IX,COI

(A , s - 010

14 Benefits paid to or for members (Part IX, col n 4

15 Salaries, other compensation, employee ben fitsVito

rpq (A^I S7- 0) 6, 015 , 033. 5 , 133, 446.

16a Professional fundraising fees (Part IX, colum

CILd

b Total fundraising expenses (Part IX, column (D), line 25)

17 Other expenses (Part IX, column (A), lines 1 la-1 1d, 11 f-24f) 5,326 , 251. 5 , 385,512.

18 Total expenses Add lines 13-17 (must equal Part IX, column (A), line 25) 11, 341 , 284. 10 , 518, 958.

19 Revenue less ex penses Subtract line 18 from line 12 - 264,196 . 1, 582, 628.

e Be inning of Year End of Year

° 20 Total assets (Part X, line 16) 1,177,703. 2,700,577.M

21 Total liabilities (Part X, line 26) 50,640 . 1,987.

LL 22 Net assets or fund balances Subtract line 21 from line 20 1, 127, 063. 2 , 698, 590.

ran II 51 nature t31ocK

Under penalties of perjur^ I declare that I have examined this retu rn, including accompany ing schedules and statements , and to the best of my knowledge and belief, it istrue, correct. and omple a Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge

Sign ► I 07- 029 - /OHere Signature of officer

► Chris BartonType or print name and title

Paid Preparer'sPre- signaturenarer'sUse

Firm ' s name (or MINAR AND NORTHEY LLP

Onlyyours if self-emoioyed). ► P.O. BOXdd d

9845a ress, anzIP + a SEATTLE

May the IRS discuss this return with the preparer shown above? (see

BAA For Privacy Act and Paperwork Reduction Act Notice , see the

Form 990 2009 District 1199 NW , Hospital & Health Care Emp. Union , SHIU , AFL-CIO 91-1275780 Page 2

Part III Statement of Program Service Accomplishments

1 Briefly describe the organization's missionWashin toa healthcare union

which re^reaents and advocates for registered nurses , licensed practical nurses,- - - --------------------------------

See Form 990, Page 2, Part III_Line 1 Scontinued) ------------------------------------------

2 Did the organization undertake any significant program services during the year which were not listed on the prior

Form 990 or 990 -EZ' Yes XQ No

If 'Yes,' describe these new services on Schedule 0

3 Did the organization cease conducting , or make significant changes in how it conducts , any program services? U Yes U No

If 'Yes,' describe these changes on Schedule O.

4 Describe the exempt purpose achievements for each of the organization ' s three largest program services by expenses Section 501(c)(3)and 501 (c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the totalexpenses , and revenue, if any , for each program service reported

4a (Code . ) (Expenses $ including grants of $ ) (Revenue $

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

4b (Code- ) (Expenses $ including grants of $ ) (Revenue $

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

4c (Code- ) (Expenses $ including grants of $ ) (Revenue $

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

------------------------------------------------------------------

4d Other program services (Describe in Schedule O )

(Expenses $ including grants of $ ) (Revenue $

4e Total program service expenses ►

BAA TEEA0102 07/20/09 Form 990 (2009)

Form 990 (2009) District 1199 NW , Hospital & Health Care Emp . Union , SEIU, AFL-CIO 91-1275780 Page 3

Part IV Checklist of Req uired SchedulesYes No

1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If 'Yes,' completeSchedule A 1 X

2 Is the organization required to complete Schedule B, Schedule of Contributors? 2 X

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidatesfor public office? If 'Yes,' complete Schedule C, Part

4 Section 501(cX3) organizations Did the organization engage in lobbying activities? If 'Yes,' completeSchedule C, Part ll .

5 Section 501 (cX4), 501 (cx5), and 501 (cX6) organizations . Is the organization subject to the section 6033(e) notice andreporting requirement and proxy tax? If 'Yes,' complete Schedule C, Part 111

6 Did the org anization maintain any donor advised funds or any similar funds or accounts where donors have the right toprovide advice on the distribution or investment of amounts in such funds or accounts? If 'Yes ,' complete Schedule D,Part I

7 Did the organization receive or hold a conservation easement, including easements to preserve open space, theenvironment, historic land areas or historic structures? If 'Yes,' complete Schedule D, Part ll

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If 'Yes,'complete Schedule D, Part Ill

9 Did the organization report an amount in Part X, line 21, serve as a custodian for amounts not listed in Part X,or provide credit counseling, debt management, credit repair, or debt negotiation services? If 'Yes,' completeSchedule D, Part IV

10 Did the organization, directly or through a related organization, hold assets in term, permanent, or quasi-endowments? If'Yes,' complete Schedule D, Part V

11 Is the organization ' s answer to any of the following questions 'Yes'? If so, complete Schedule D, Parts VI, VII, VIII, IX, or

3 X

4

5 X

6 X

7 X

8 X

9 X

1 10 X

X as applicable 11 X

• Did the organization report an amount for land, buildings and equipment in Part X, line 10'7 If 'Yes,' complete ScheduleD, Part VI

• Did the organization report an amount for investments- other securities in Part X, line 12 that is 5% or more of its totalassets reported in Part X, line 167 If 'Yes,' complete Schedule D, Part VII

• Did the organization report an amount for investments- program related in Part X, line 13 that is 5% or more of its totalassets reported in Part X, line 16' If 'Yes,' complete Schedule D, Part VIII

• Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported inPart X, line 16' If 'Yes,' complete Schedule D, Part IX

• Did the organization report an amount for other liabilities in Part X, line 25' If 'Yes,' complete Schedule D, Part X

• Did the organization's separate or consolidated financial statements for the tax year include a footnote that addressesthe organizaiton's liability for uncertain tax positions under FIN 487 If'Yes,' complete Schedule D, Part X

12 Did the organization obtain separate, independent audited financial statement for the tax year? If 'Yes,' completeSchedule D, Parts Xl, XII, and Xlll 12 X

12AWas the organization included in consolidated, independent audited financial statement for the tax Yes No

year? If 'Yes,' completing Schedule D, Parts XI, Xll, and Xlll is optional 12 A X

13 Is the organization a school described in section 170(b)(1)(A)(ii)'' If 'Yes,' complete Schedule E 13 X

14a Did the organization maintain an office, employees, or agents outside of the United States? 14a X

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising,business, and program service activities outside the United States? If 'Yes,' complete Schedule F, Part I 14b X

15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organizationor entity located outside the United States? If 'Yes,' complete Schedule F, Part ll 15 X

16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance toindividuals located outside the United States? If 'Yes,' complete Schedule F, Part 111 16 X

17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,column (A), lines 6 and 11 e? If 'Yes,' complete Schedule G, Part 1 17 X

18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII,lines 1c and 8a' If 'Yes,' complete Schedule G, Part ll 18 X

19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If 'Yes,'complete Schedule G, Part 111 19 X

20 Did the organization operate one or more hospitals? If 'Yes,' complete Schedule H 20 X

BAA TEEA0103 02/12/10 Form 990 (2009)

Form 990 (2009) District 1199 NW , Hospital & Health Care Smp. Union , SHIU , APL-CIO 91-1275780 Page 4

Part IV Checklist of Req uired Schedules continuedYes No

21 Did the organization report more than $5,000 of grants and other assistance to governments and organizations in theUnited States on Part IX, column (A), line 1 ? If 'Yes,' complete Schedule I, Parts I and 11 21 X

22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on PartIX, column (A), line 2' If 'Yes,' complete Schedule 1, Parts I and 111 22 X

23 Did the organization answer 'Yes' to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's currentand former officers, directors, trustees, key employees, and highest compensated employees? If 'Yes,' completeSchedule J 23 X

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000as of the last day of the year, and that was issued after December 31, 2002' If 'Yes,' answer lines 24b through 24d andcomplete Schedule K If 'No,'go to line 25 24a X

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b

c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defeaseany tax-exempt bonds? 24c

d Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year? 24d

25a Section 501(cx3) and 501 (cx4) organizations . Did the organization engage in an excess benefit transaction with adisqualified person during the year? If 'Yes,' complete Schedule L, Part I 25a

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, andthat the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If 'Yes,' completeSchedule L, Part I 25b

26 Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, ordisqualified person outstanding as of the end of the organization's tax year If 'Yes,' complete Schedule L, Part 11 26 X

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantialcontributor, or a grant selection comittee member, or to a person related to such an individuals If 'Yes,' completeSchedule L, Part 111 27 X

28 Was the organization a party to a business transation with one of the following parties (see Schedule L, Part IVinstructions for applicable filing thresholds, conditions, and exceptions) __

a A current or former officer, director, trustee, or key employee? If 'Yes,' complete Schedule L, Part IV 28a X

b A family member of a current or former officer, director, trustee, or key employee? If 'Yes,' completeSchedule L, Part IV 28b X

c An entity of which a current or former officer, director, trustee, or key employee of the organization (or a family member)was an officer, director, trustee, or direct or indirect owner? If 'Yes,' complete Schedule L, Part IV 28c X

29 Did the organization receive more than $25,000 in non-cash contributions? If 'Yes,' complete Schedule M 29 X

30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservationcontributions? If 'Yes,' complete Schedule M 30 X

31 Did the organization liquidate, terminate, or dissolve and cease operations? If 'Yes,' complete Schedule N, Part 1 31 X

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If 'Yes,' completeSchedule N, Part 11 32 X

33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections301 7701.2 and 301 7701.3' If 'Yes,' complete Schedule R, Part 1 33 X

34 Was the organization related to any tax-exempt or taxable entity? If 'Yes,' complete Schedule R, Parts II, Ill, IV, and V,line 1 34 X

35 Is any related organization a controlled entity within the meaning of section 512(b)(13)'' If 'Yes,' complete Schedule R,Part V, line 2 35 X

36 Section 501(cX3) organizations . Did the organization make any transfers to an exempt non-charitable relatedorganization? If 'Yes,' complete Schedule R, Part V, line 2 36

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that istreated as a partnership for federal income tax purposes? If 'Yes,' complete Schedule R, Part VI 37 X

38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 and 19?Note . All Form 990 filers are req uired to comp lete Schedule 0 38 X

BAA Form 990 (2009)

TEEA0104 02/12110

Form 990 (2009) District 1199 NW . Hospital & Health Care Emp . Union , SEIU , AFL-CIO 91-1275780 Page 5

Part V Statements Regarding Other IRS Filings and Tax Compliance

1 a Enter the number reported in Box 3 of form 1096, Annual Summary and Transmittal of U.SInformation Returns Enter -0- if not applicable 1 a

b Enter the number of Forms W-2G included in line la Enter -0- if not applicable 1 b

c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming(gambling) winnings to prize winners?

2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for thecalendar year endin g with or w i thin the year covered by this return 2a

2b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note . If the sum of lines 1a and 2a is greater than 250, you may be required to e-file this return (see instructions)

3a Did the organization have unrelated business gross income of $1,000 or more during the year covered bythis return?

b If 'Yes' has it filed a Form 990-T for this year? If 'No,' provide an explanation in Schedule 0

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, afinancial account in a foreign country (such as a bank account, securities account, or other financial account)?

b If 'Yes,' enter the name of the foreign country.

See the instructions for exceptions and filing requirements for Form TD F 90-22 1, Report of Foreign Bank andFinancial Accounts

5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?

b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

c If 'Yes,' to line 5a or 5b, did the organization file Form 8886-T, Disclosure by Tax-Exempt Entity Regarding ProhibitedTax Shelter Transaction?

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organizationsolicit any contributions that were not tax deductible?

b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were notdeductible?

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and servicesprovided to the payor?

b If 'Yes,' did the organization notify the donor of the value of the goods or services provided?

c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to fileForm 8282'

d If 'Yes,' indicate the number of Forms 8282 filed during the year I 7d1

e Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personalbenefit contract?

f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

g For all contributions of qualified intellectual property, did the organization file Form 8899 as required?

h For contributions of cars, boats, airplanes, and other vehicles, did the organization file a Form 1098-C as required?

8 Sponsoring organizations maintaining donor advised funds and section 509(aX3) supporting organizations . Did thesupporting organization, or a donor advised fund maintained by a sponsoring organization, have excess businessholdings at any time during the year?

9 Sponsoring organizations maintaining donor advised funds.

a Did the organization make any taxable distributions under section 4966'

b Did the organization make any distribution to a donor, donor advisor, or related person'

10 Section 501(c)(7) organizations. Enter

a Initiation fees and capital contributions included on Part VIII, line 12 10a

b Gross Receipts, included on Form 990, Part VIII, line 12, for public use of club facilities 10b

11 Section 501(cx12) organizations. Enter

a Gross income from other members or shareholders 11 a

b Gross income from other sources (Do not net amounts due or paid to other sources againstamounts due or received from them) 11 b

12a Section 4947(aXi) non -exempt charitable trusts . Is the organization filing Form 990 in lieu of Form 1041

b If 'Yes,' enter the amount of tax-exempt interest received or accrued during the year 112 bl

BAA

Yes No

1409

14 0 A2b X

3a X

4a X

5a X

5b X

5c

6a X

6b

7a X

7c X

7e X

7f X

7 X

7h X

8

12a1---- I---^

Form 990 (2009)

TEEA0105 02/12/10

Form 990 (2009) District 1199 NW , Hospital & Health Care Emp. Union, SEIU , AFL-CIO 91-12757 80 Page 6

Part VI Governance, Management and Disclosure For each 'Yes' response to lines 2 through 7b below, and fora 'No' response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes InSchedule 0. See Instructions.

Section A. Governing Body and ManagementYes No

1 a Enter the number of voting members of the governing body 1 a 92

b Enter the number of voting members that are independent lb 92

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other - - ----Iofficer, director, trustee or key employee? 2 X

3 Did the organization delegate control over management duties customarily performed by or under the direct supervisionof officers, directors or trustees, or key employees to a management company or other person'? 3 X

4 Did the organization make any significant changes to its organizational documents 4 X

since the prior Form 990 was filed?

5 Did the organization become aware during the year of a material diversion of the organization's assets? 5 X

6 Does the organization have members or stockholders? 6 X

7a Does the organization have members, stockholders, or other persons who may elect one or more members of thegoverning body? 7a X

b Are any decisions of the governing body subject to approval by members, stockholders, or other persons? 7b X

8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year bythe following

a The governing body's a X

b Each committee with authority to act on behalf of the governing body? 8b X

9 Is there any officer, director or trustee, or key employee listed in Part VII, Section A, who cannot be reached at theorganization's mailing address? If 'Yes,' provide the names and addresses in Schedule 0 9 X

Section B. Policies (This Section B requests information about policies not required by the Internal

Revenue Code)Yes No

10a Does the organization have local chapters, branches, or affiliates? 10a X

b If 'Yes,' does the organization have written policies and procedures governing the activities of such chapters, affiliates,and branches to ensure their operations are consistent with those of the organization? 10b

11 Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form? 11 X

11 A Describe in Schedule 0 the process, if any, used by the organization to review this Form 990.

12a Does the organization have a written conflict of interest policy? If 'No,' go to line 13 12a X

b Are officers, directors or trustees, and key employees required to disclose annually interests that could give riseto conflicts? 12b X

c Does the organization regularly and consistently monitor and enforce compliance with the policy? If 'Yes,' describe inSchedule 0 how this is done 12c X

13 Does the organization have a written whistleblower policy? 13 X

14 Does the organization have a written document retention and destruction policy? 14 X

15 Did the process for determining compensation of the following persons include a review and approval by independentpersons, comparability data, and contemporaneous substantiation of the deliberation and decision? _

a The organization's CEO, Executive Director, or top management official 15a X

b Other officers of key employees of the organization 15b X

If 'Yes' to line 15a or 15b, describe the process in Schedule 0 (See instructions )

16a Did the organization invest in, contribute assets to, or participate in a point venture or similar arrangement with a taxable - - -^entity during the year? 16a X

b If 'Yes,' has the organization adopted a written policy or procedure requiring the organization to evaluate its participationin joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization's exempt ------Jstatus with respect to such arrangements' 16b

Section C . Disclosures17 List the states with which a copy of this Form 990 is required to be filed

-----------------------------18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (501 (c)(3)s only) available for public

inspection Indicate how you make these available Check all that apply.

11 Own website E] Another's website Xl Upon request

19 Describe in Schedule 0 whether (and if so, how) the organization makes its governing documents, conflict of interest policy, and financialstatements available to the public

20 State the name, physical address, and telephone number of the person who possesses the books and records of the organization

"Frank Kiuchi 15 South Grady Way , Suite 200 Renton WA 98057 (425) 917-1199----------------------------------------------------------------

BAA Form 990 (2009)

TEEA0106 02/05/10

Form 990 (2009) District 1199 NW , Hospital 5. Health Care Emp. Union , SEIU, AFL-CIO 91-1275780 Page 7

Part VII Com pensation of Officers , Directors , Trustees , Key Employees, Highest CompensatedEmployees, and Independent Contractors

Section A . Officers , Directors, Trustees , Key Employees, and Highest Compensated Employees

1 a Complete this table for all persons required to be listed Report compensation for the calendar year ending with or within theorganizations's tax year Use Schedule J-2 if additional space is needed

• List all of the organization's current officers directors, trustees (whether individuals or organizations), regardless of amount ofcompensation Enter -0- in columns (D), (E), and (F) if no compensation was paid.

• List all of the organization's current key employees See instructions for definition of 'key employees

• List the organization' s five current highest compensated employees (other than an officer, director, trustee, or key employee) whoreceived reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and anyrelated organizations.

• List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 ofreportable compensation from the organization and any related organizations.

• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of theorganization, more than $10,000 of reportable compensation from the organization and any related organizations

List persons in the following order individual trustees or directors, institutional trustees, officers, key employees, highest compensatedemployees; and former such persons

n Check this box if the organization did not compensate any current officer, director, or trustee

(A) (B) (c) (D) (E) (F)

Name and Title Averageh

Position (check all that apply) Reportable Reportable Estimatedours

per week Elt 1:compensation fromthe or anization

compensation fromrelated or anizations

amount of othercom ensationg

(W-2/1099 - MISC)g

(W -2/1099 - MISC)p

from the? t

L.-z 9 u norganiza ionand related

organ i zations

c a

2d

Chris Barton---------------------Secretary - Treasurer 40.00 X X 97 , 585. 0. 20,451.

Marcelle Johnsen---------------------Vice President - Public 40.00 X X 18 , 999. 0. 0.

Grace Land---------------------Vice President - Private 1 . 00 X X 0. 0. 0.

Diane Sosne---------------------President 40.00 X X 106 , 800. 0. 20,703.

_Emi_ljr VanBronkhorst_ _ _ _ _ _

Executive Vice President 40.00 X X 96,520. 0 . 25,781.

Nancy Westbr_o_o_k_________

Executive Board 1 . 00 X 303. 0. 0.

Sarah Voline---------------------Executive Board 1 . 00 X 325. 0. 0.

Lisa un er

Executive Board 1 . 00 X 1 , 967. 0. 0.

Ray Tucker------------


Deeanna Swenson---------------------Executive Board 1 . 00 X 0. 0. 0.

Charlotte Anibas---------------------Executive Board 1 . 00 X 402. 0. 0.

Linda Arkava---------------------Executive Board 1.00 X 6 , 196. 0. 0.

Beverly Ann Barker


Gai1Bis_ch_ofbe_rger ______

Executive Board 1.00 X 3,033. 0. 0.

David Black---------------------Executive Board 1 . 00 X 527. 0. 0.

Debra Borden---------------------Executive Board 1 . 00 X 294. 0. 0.

_!Lay Bo le


BAA TEEA01o7 11noio9 Form 990 (2009)

Form 990 (2009) Distri ct 1199 NW, Hospital & Health Care Emp. Union , SEIU , APL-CIO 91-1275780 Page 8

Part VII Section A. Officers , Directors , Trustees ey Employees , and Hi hest Compensated Em to ees (cont. )

• (A) (B) (c) (D) (E) (F)

Name and Title Averageh

Position (check all that apply) Reportable Reportable Estimatedours

per wee ° a c 3 ocompensation fromthe organization

compensation fromrelated organizations

amount of othercompensation

W o (W-2/1099-MISC) (W-2/1-MISC) from the

d

3

norganizationand related

2r dCD

3 organizations

MN

N

7

G

Jose h Brid es

Executive Board 1.00 X 892. 0. 0.

Dianne Brown---------------------------Executive Board 1.00 X 3,186. 0. 0.

Grace Yang_------- ------------------Executive Board 1.00 X 0. 0. 0.

Shelley Burnett----- --------------Executive Board 1.00. x 1,201. 0. 0.

Konnie Cam a na


Scott Canada _ _ _ - _ _--------- ----------Executive Board 1.00 X 6,789. 0. 0.

Tina Caryenter------ ---------------Executive Board 1.001 X 1,578. 0. 0.

Jose h Chartier


Nancy Clark-------------------


Kathline ClaPoo1 _ _ _ _ _--------- --------Executive Board 1.00 X 786. 0. 0.

Bonnie -Cooper


Micki-Dextre--------------------------Executive Board 1.00 X 681. 0. 0.

Michael Dyer-------

1Executive Board 1.00 X 1,937. 0. 0.

1b Total ' 428,718. 0. 66,935.

2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation

from the organization 0. 1

Yes No

3 Did the organization list any former officer, director or trustee, key employee , or highest compensated employee --- ---ion line 1 a? If 'Yes,' complete Schedule J for such individual 3 X

4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation fromthe organization and related organizations greater than $150 , 000? If ' Yes' complete Schedule J for suchindividual 4 X

5 Did any person listed on line la receive or accrue compensation from any unrelated organization for servicesrendered to the organization' If 'Yes,' complete Schedule J for such person 5 X

Section B. Independent Contractors1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of

compensation from the organization

(A)Name and business address

(B)Descrl tlon of Services

(C)Com p ensation

Douglas , Drachler 4 Dick 1904 Third Avenue Seattle WA 98101 Legal 305,843.

2 Total number of independent contractors (including but not limited to those listed above) who received more than

$100,000 in com p ensation from the organization 9* 1

BAA TEEA0108 01/30/10 Form 990 (2009)

Form 990 (2009) District 1199 NW , Hospital & Health Care Hmp. union , SHID , APL-CIO 91-1275780 Page 9

Part VIII Statement of Revenue

(A) (B) Ce a

DTotal revenue Related or Unr l ted Revenue

exempt business excluded from taxfunction revenue under sectionsrevenue 512, 513, or 514

1 a Federated campaigns 1 aZm b Membership dues 1 b 11,751,689.

N c Fundraising events 1 cQ d Related organizations 1 d

M e Government grants (contributions) 1 e

f All other contributions, gifts, grants, andsimilar amounts not included above 1 f 213,569.

_ = g Noncash contrlbns included in Ins la-if $U0c h Total . Add lines la- lf 11, 965, 258.

Business Code

W 2a Reimbursed expenses 900099 121 ,739. 121,739. 0. 0.---------b- - - - - - - - - - - - - - - - - -

U C

- - - - - - - - - - - - - - - - - -

d------------------

e

o f All other program service revenue

d Total . Add lines 2a-2f 121,739.

3 Investment income (including dividends, interest andother similar amounts) 9,843 . 0. 0. 9,843.

4 Income from investment of tax-exempt bond proceeds

5 Royalties(i) Real (it) Personal

6a Gross Rents

b Less rental expenses

c Rental income or (loss)

d Net rental income or (loss

7a Gross amount from sales of(i) Securities (it) Other

assets other than inventory

b Less cost or other basisand sales expenses

c Gain or (loss) - - - - -d Net gain or (loss)

8a Gross income from fundraising events_ (not including $

of contributions reported on line 1c)

See Part IV, line 18 a

b Less direct expenses b0

c Net income or (loss) from fundraising eve nts

9a Gross income from gaming activitiesSee Part IV, line 19 a

b Less direct expenses b

c Net income or (loss) from gaming activities

10a Gross sales of inventory, less returnsand allowances a

b Less- cost of goods sold b

c Net income or ( loss ) from sales of inventorMiscellaneous Revenue Business Code

11a Miscellaneous income------------------

9000999 4,746 . 4,746. 0. 0.

b------------------

c------------------

d All other revenue

e Total . Add lines 11a-11d 4,746.1

12 Total revenue . See instructions 1-1 12 , 101, 5 8 6 . 126,485. 1 0 . 9,843.

BAA TEEAO109 ovitito Form 990 (2009)

Form 990 2009 District 1199 NW . Hospital a Health Care Emp. Union , SEIU , AFL-CIO 91-1275780 Pag e 10

Part IX Statement of Functional ExpensesSection 501(cx3) and 501(cX4) organizations must complete all columns.

A ll otner organizations must complete column kA) out are not requires no compiene columns tat, tut, anu tut.

Do not include amounts reported on lines6b, 7b, 8b, 9b, and 10b of Part V///,

(A)Total expenses

(B)Program service

ex p enses

(C)Management andgeneral ex p enses

(D)Fundraisingex p enses

1 Grants and other assistance to governmentsand organizations in the U S See Part IV,line 21

2 Grants and other assistance to individuals inthe U S. See Part IV , line 22

3 Grants and other assistance to governments,organizations , and individuals outside theU S See Part IV, lines 15 and 16

4 Benefits paid to or for members5 Compensation of current officers , directors,

trustees , and key employees 433,399.

6 Compensation not included above, todisqualified persons (as defined undersection 4958 (f)(1) and persons described insection 4958 (c)(3)(B)

7 Other salaries and wages 3,237,002.

8 Pension plan contributions ( include section401(k) and section 403 ( b) employercontributions) 418, 856.

9 Other employee benefits 711,433.

10 Payroll taxes 332, 756.

11 Fees for services (non-employees)

a Management

b Legal 413,103.

c Accounting 16,000.

d Lobbying

e Prof fundraising svcs See Part IV, In 17

f Investment management fees

g Other 98,370.

12 Advertising and promotion

13 Office expenses 301, 656.

14 Information technology 26,567.

15 Royalties

16 Occupancy 243, 939.

17 Travel 154,299.18 Payments of travel or entertainment

expenses for any federal , state, or localpublic officials

19 Conferences , conventions , and meetings 60,421.

20 Interest

21 Payments to affiliates 2, 907, 130.

22 Depreciation , depletion , and amortization 39,337.

23 Insurance 2,595.24 Other expenses . Itemize expenses not

covered above . (Expenses grouped togetherand labeled miscellaneous may not exceed5% of total expenses shown on line 25below )

aBank charges and fees 3,519.

_b_Coalition- expense ____ 23,333.___

Colntnunicati_on expensec 14,164._ __ _ _ _ _ _

dDonations 66,690.----------------------eDues andsubscriptions 1,351._____

f All other expenses 1,013,038.

25 Total functional ex penses . Add lines 1 throu gh 24f 10,518,958.

26 Joint costs . Check here ► if followingSOP 98 - 2. Complete this line only if theorganization reported in column (B) jointcosts from a combined educationalcam p ai g n and fundraisin g solicitation

BAA Form 990 (2009)

TEEA0110 02/05/10

Form 990 (2009) District 1199 NW . Hospital & Health Care Emp. Union , SBIU , AFL-CIO 91-1275780 Page 11

Part X Balance Sheet

• (A) (B)Beginning of year End of year

1 Cash - non-interest-bearing 1

2 Savings and temporary cash investments 814,026 . 2 2,361,753.

3 Pledges and grants receivable, net 3

4 Accounts receivable, net 4

5 Receivables from current and former officers, directors, trustees, key employees,and highest compensated employees Complete Part II of Schedule L 5

6 Receivables from other disqualified persons (as defined under section 4958(f)(1))

and persons described in section 4958(c)(3)(B). Complete Part II of Schedule L 6A

7 Notes and loans receivable, net 7

E 8 Inventories for sale or use 8T

9 Prepaid expenses and deferred charges 9

10a Land, buildings, and equipment: cost or other basis 10a 426,363.

Complete Part VI of Schedule D

b Less- accumulated depreciation 10b 310 , 783. 134, 468. 10c 115, 580.

11 Investments - publicly-traded securities .. 197, 672. 11 187, 707.

12 Investments - other securities See Part IV, line 11 12

13 Investments - program-related See Part IV, line 11 13

14 Intangible assets 14

15 Other assets See Part IV, line 11 31,537. 15 35,537.

16 Total assets Add lines 1 throug h 15 (must eq ual line 34) 1, 177, 703. 16 2, 700, 577.

17 Accounts payable and accrued expenses 7,285. 17 1,987.

18 Grants payable 18

19 Deferred revenue 43,355. 19

20 Tax-exempt bond liabilities 20

B 21 Escrow or custodial account liability Complete Part IV of Schedule D 21

L 22 Payables to current and former officers, directors, trustees, key employees,1 highest compensated employees, and disqualified persons. Complete Part IIT

i of Schedule L 22E

23 Secured mortgages and notes payable to unrelated third parties 23

24 Unsecured notes and loans payable to unrelated third parties 24

25 Other liabilities. Complete Part X of Schedule D 25

26 Total liabilities . Add lines 17 through 25 50,640 . 26 1,987.

N Organizations that follow SFAS 117, check here ► and complete lines

T 27 through 29 and lines 33 and 34.

A 27 Unrestricted net assets 1,117,771. 27 2, 698,590.

E 28 Temporarily restricted net assets 9,292. 28

29 Permanently restricted net assets 29

R Organizations that do not follow SFAS 117, check here ► and complete

F lines 30 through 34. _N 30 Capital stock or trust principal, or current funds 30

A 31 Paid-in or capital surplus, or land, building, and equipment fund 31

A 32 Retained earnings, endowment, accumulated income, or other funds 32N

33 Total net assets or fund balances 1,127,0 63. 33 2 , 698,590.

s 34 Total liabilities and net assets/fund balances 1,177,7 03. 34 2 ,700,577.

BAA Form 990 (2009)

TEEA0111 01/30/10

Form 990 (2009) District 1199 NW , HOepital & Health Care Emp. Union , SEXU, AFL -CIO 91-1275780 Page 12

Part XI Financial Statements and Reportin gYes No

1 Accounting method used to prepare the Form 990 Cash 11 Accrual E] Other

If the organization changed its method of accounting from a prior year or checked 'Other,' explainin Schedule 0

2a Were the organization's financial statements compiled or reviewed by an independent accountant? 2a X

b Were the organization's financial statements audited by an independent accountant? 2b X

c If 'Yes' to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,review, or compilation of its financial statements and selection of an independent accountant? 2c X

If the organization changed either its oversight process or selection process during the tax year, explainin Schedule O.

d If 'Yes' to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on aconsolidated basis, separate basis, or both

Consolidated basis Both consolidated and separate basis© Separate basis 11 El3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single

Audit Act and OMB Circular A-133? 3a X

b If 'Yes,' did the organization undergo the required audit or audits? If the organization did not undergo the required auditor audits, ex p lain why in Schedule 0 and describe any ste p s taken to undergo such audits 3b

BAA Form 990 (2009)

lEEA0112 02/05/10

SCHEDULE J-2(Form 990)

Department of the TreasuryInternal Revenue Service

Continuation Sheet for Form 990

Attach to Form 990 to list additional information for Form 990, Part VII, Section A , line 1a.See instructions for Form 990.

1 2009Open to Public

Inspection

Name of the Organization

OMB No 1545-0047

Employler Identification number

Part I Continuation: Officers, Directors, Trustees, Key Employees, and Highest CompensatedEm to ees

(A) (B) (C) (D) (E) (F)

Name and Title Average hours Position (check all that apply) Reportable Reportable Estimatedper week o = ,

'

0 = m compensat ion fromthe org an i zation

compensation fromrelated or g anizat i ons

amount of othercompensationa c M 3 6

9 (W-2/1099 - MISC) (W - 2/1099-MISC) from then 6 ° fD m or anizationd o C n

gand related

dCD

3 organizat i ons

CD

ma

Bonnie Edwards------------------Executive Board 1 . 00 X 873. 0. 0.

Sherry-Edwards_______


Suzanne Clinkenbeard------------------Executive Board 1 . 00 X 0. 0. 0.

Mercy Curt i s ________


Barbara Davis------------------Executive Board 1 . 00 X 716. 0. 0.

Steven Felton------------------Executive Board 1.00 X 0. 0. 0.

Kimberly Field_


_Valerie _F_ink1ey______


Thad Stevens------------------Executive Board 1 . 00 X 1,287. 0. 0.

Maw Gibbs


Kathleen Gibson------------------Executive Board 1 . 00 X 824. 0. 0.

David Gilliam------------------Executive Board 1 . 00 X 0. 0. 0.

Chester Gist------------------Executive Board 1.00 X 0. 0. 0.

-Fa-ncy Gladsjo _______


Levorn Glover------------------Executive Board 1 . 00 X 761. 0. 0.

Barbara Goebel------------------Executive Board 1 . 00 X 560. 0. 0.

Daniel Gosser------------------Executive Board 1 . 00 X 1 , 614. 0. 0.

Carle Griffin------------------Executive Board 1 . 00 X 155. 0. 0.

Diane Gross------------------Executive Board 1 . 00 X 857. 0. 0.

Clarita Guanlao------------------Executive Board 1.00 X 2 , 147. 0. 0.

Dana Guinn------------------Executive Board 1.00 X 848. 0. 0.

9AA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J-2 (Form 990) 2009

TEEA4301 06/25/09



OMB No 1545-0047

Continuation Sheet for Form 990 2009

Attach to Form 990 to list additional information for Form 990 , Part VII , Section A, line 1a.See instructions for Form 990 . Open to Public

Inspection


Part I Continuation: Officers, Directors, Trustees, Key Employees, and Highest CompensatedEmployees

(A) (B) (C) (D) (E) (F)

Name and Title Average hours Position (check all that apply) Reportable Reportable Estimatedper week

-

m compensation from compensation from amount of other7 7

rn 3 the organization related organizations compensationa c

so 3 (W-211099-MISC) (W-2/1099-MISC) from the

aS

?o

organizationand related

- d 0

is

3 organizations

i N

NN

IVa

d

Robert Gutierrez------------------Executive Board 1.00 X 1,049. 0. 0.

Geor3etta Hac_hiYa ____


Susan Harmon------------------Executive Board 1.00 X 926. 0. 0.

Celeste Harris------------------Executive Board 1.00 X 139. 0. 0.

Heather Harve o


Heera Varinder------------------Executive Board 1.00 X 1,229. 0. 0.

Sandra Heinzle------------------Executive Board 1.00 X 608. 0. 0.

Will iam Hicke


Patricia Hunter------------------Executive Board 1.00 X 0. 0. 0.

Donald_Stenzel_ _ _ _ _ _ _Executive Board 1.00 X 475. 0. 0.

Lup-e White--------------


Ma_Rel_1_ey_________


Sharon Rile------------------Executive Board 1.00 X 0. 0. 0.

Bridget Knight


KoriLane Lacy


Per Whitaer


Joel Le Bon------------------Executive Board 1.00 X 232. 0. 0.

Auro^rn Lee----l ------------Executive Board 1.00 X 1,020. 0. 0.

Tara Larew------------------Executive Board 1.00 X 0. 0. 0.

Derek Low------------------Executive Board 1.00 X 385. 0. 0.

Chri s-Mal lory _______


9AA For Privacy Act and Paperwork Reduction Act Notice. see the Instructions for Form 990 . Schedule J-2 (Form 990) 2009


TEEA4301 06/25/09




Attach to Form 990 to list additional information for Form 990, Part VII, Section A, line 1a.See instructions for Form 990.

OMB No 1545 0047


Inspection

Name of the Organization Employler Identification number

Part I Continuation: Officers, Directors, Trustees, Key Employees, and Highest CompensatedEmolovees

(A) (B) (C) (D) (E) (F)

Name and Title Average hours Position (check all that apply) Reportable Reportable Estimatedper week = T compensation from

hcompensation from

lamount of other7

a D o t e organization re ated organ zations compensationQ

a.

c

tD ° m(W-2/1099-MISC) (W 2/1099-MISC ) from the

S vEo D

^ aI

organizationand related

is

a

N

N

^0

(is

9

ad

organizat i ons

MaU McNaughton_ _ _ _ - -


Jennifer Marks------------------Executive Board 1.00 X 0. 0. 0.

_S_he_ryl _Martin_______


Joel McCulloch


Don Miller------------------Executive Board 1.00 X 3 , 635. 0. 0.

Diane Moller------------------Executive Board 1 . 00 X 2,313. 0. 0.

Kenneth Myers


Victoria Neumeier------------------Executive Board 1 . 00 X 2 , 235. 0. 0.

Teresa Nicholson------------------Executive Board 1 . 00 X 317. 0. 0.


Dawn Orden------------------Executive Board 1 . 00 X 1 , 147. 0. 0.

Marie ( Toni ) Penuel- --- .Board 1 . 00 X 1,211. 0. 0.

Cheri Puetz------------------Executive Board 1.00 X 1,524. 0. 0.

Maw Reynolds _______


Edward_Robertson _ _ _ _ - -Executive Board 1.00 X 877. 0. 0.

Nathan-Rozeboom----- _


Darla Saville------------------Executive Board 1 . 00 X 0. 0. 0.

Shirley Sims ____-_-_

Executive Board 1 . 00 X 1,286. 0. 0.

Raren_Spafford ______


Margaret _S t _a_r_ns______

Executive Board 1 . 00 X 2,705. 0. 0.

-------------------

9AA For Privacv Act and Pauerwork Reduction Act N otice . see the Instructions for Form 990. Schedule J-2 (Form 990) 2009

TEEA4301 06/25/09




► Attach to Form 990 to list additional information for Form 990, Part VII, Section A , line 1 a.► See instructions for Form 990.


Inspection


OMB No 1545-0047


PartI Continuation: Officers, Directors, Trustees, Key Employees, and Highest CompensatedEm to ees

(A)

Name and Title

(B)

Average hours

(C)Posit i on (check all that apply)

(D)

Reportable

(E)

Reportable

(F)

Estimatedper week

a a

aBE

N_ry

c

o

C

A

N

=

,

3

IU

Ton

a

compensat ion fromthe org anizat i on(W-2/1099 - MISC)

compensation fromrelated or ganizations(W 2 / 1099-MISC )

amount of othercompensation

from theorganizationand related

organizations

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - --

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - --

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - --

- - - - - - - - - - - - - - - - - --

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - --

- - - - - - - - - - - - - - - - - --

- - - - - - - - - - - - - - - - - --

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - -

9AA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J-2 (Form 990) 2009

TEEA4301 06/25/09

SCHEDULE C Political Campaign and Lobbying Activities(Form 990 or 990-EZ)

For Organizations Exempt From Income Tax Under section 501 (c) and section 527

Complete if the organization is described below.Department of the TreasuryInternal Revenue Serv i ce Attac h to Form 990 or Form 990- EZ. ► See separate instructions.

OMB No 1545-0047


Inspection

If the organization answered ' Yes,' to Form 990, Part IV, line 3, or Form 990-EZ , Part VI , line 46 (Political Campaign Activities), then

• Section 501(c)(3) organizations complete Parts I-A and B Do not complete Part I-C

• Section 501(c) (other than section 501 (c)(3)) organizations complete Parts I-A and C below Do not complete Part I-B.

• Section 527 organizations complete Part I-A only

If the organization answered 'Yes; to Form 990, Part IV , line 4, or Form 990-EZ , Part VI, line 47 (Lobbying Activities), then

• Section 501 (c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A Do not complete Part II-B.

• Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)) Complete Part II-B Do not completePart II-A

If the organization answered 'Yes, to Form 990, Part IV , line 5 (Proxy Tax), then

• Section 501 (c)(4). (5). or (6) organizations Complete Part III

Name of organization Employer identification number

District 1199 NW , Hospital & Health Care Emp . Union , SEIU , AFL -CIO91- 1275780

Part I-A Complete if the org anization is exempt under section 501 (c) or is a section 527 organization.

1 Provide a description of the organization's direct and indirect political campaign activities in Part IV

2 Political expenditures $

3 Volunteer hours

Part I-B Complete if the organization is exempt under section 501(cX3).1 Enter the amount of any excise tax incurred by the organization under section 4955 $

2 Enter the amount of any excise tax incurred by organization managers under section 4955 $

3 If the organization incurred a section 4955 tax, did it file Form 4720 for this year?

H

Yes

H

No

4a Was a correction made? Yes No

b If 'Yes,' describe in Part IV

Part I -C Complete if the organization is exempt under section 501 (c), except section 501(cx3).

1 Enter the amount directly expended by the filing organization for section 527 exempt function activities $

2 Enter the amount of the filing organization's funds contributed to other organizations for section 527 exemptfunction activities $

3 Total of exempt function expenditures Add lines 1 and 2 Enter here and on Form 1120-POL,line 17b $

4 Did the filing organization file Form 1120-POL for this year' Yes X No

5 Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which payments weremade For each organization listed, enter the amount paid from the filing organization's funds Also enter the amount of politicalcontributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fundor a political action committee (PAC) If additional space is needed, provide information in Part IV

(a) Name (b) Address (c) EIN (d) Amount paid from filingorganization ' s funds

If none, enter - 0-

(a) Amount of politicalcontribut i ons received and

promptly and directlydelivered to a separatepol i tical organization

It none, enter 0

District 1199 NW SEIU PAC 1 5 South Gra

Renton WA98057 91-1275780 0. 1,679.

-------------------

-------------------

-------------------

-------------------

- - - - - - - - - - - - - - - - - - --

BAA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule C (Form 990 or 990-EZ) 2009

TEEA3201 02/05/10

Schedule C (Form 990 or 990-EZ) 2009District 1199 NW, Hosp ital a Health Care Emp . Union, SEIU, AFL-CIO 91-1275780 Page 2

Part II -A Complete if the organization is exempt under section 501(cX3) and filed Form 5768 (election undersection 501(h)).

A Check ►

H

if the filing organization belongs to an affiliated group

B Check ► if the filing organization checked box A and 'limited control' p rovisions a pply

Limits on Lobbying Expenditures - (a) Filing (b ) Affiliated

(The term 'expenditures ' means amounts paid or incurred .) organization's totals group totals

1 a Total lobbying expenditures to influence public opinion (grass roots lobbying)

b Total lobbying expenditures to influence a legislative body (direct lobbying)

c Total lobbying expenditures (add lines 1 a and 1 b)

d Other exempt purpose expenditures

e Total exempt purpose expenditures (add lines lc and Id)

f Lobbying nontaxable amount Enter the amount from the following table inboth columns

If the amount on line le , column ( a) or (b ) is: he lobbying nontaxable amount is:

Not over $500,000 20% of the amount on line le.

Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000

Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000

Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000

Over $11,000,000 $1,000,000

g Grassroots nontaxable amount (enter 25% of line If)

In Subtract line 1 g from line la If zero or less, enter -0-

i Subtract line If from line 1c If zero or less, enter -0-

j If there is an amount other than zero on either line 1 h or line 11, did the organization file Form 4720 reportingsection 4911 tax for this year ? n Yes n No

4-Year Averaging Period Under Section 501(h)(Some organizations that made a section 501(h ) election do not have to complete all of the five

columns below . See the instructions for lines 2a through 2f.)

Lnhhvinn Expenditures Durina 4-Year Averaaina Period

Calendar year (or fiscalyear beginning in)

(a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) Total

2a Lobbying non-taxableamount

b Lobbying ceilingamount (150% of line2a, column (e) )

c Total lobbyingex penditures

d Grassroots nontaxableamount

e Grassroots ceilingamount (150% of line2d, column (e) )

f Grassroots lobbyingex penditures

BAA Schedule C (Form 990 or 990-EL) 2009

TEEA3202 02/05110

Schedule C (Form 990 or 990-EZ) 2009District 1199 NW, Hosp ital & Health Care Emp . Union, SEIU , AFL-CIO 91-1275780 Page 3

Part II-B Complete if the organization is exempt under section 501(cx3) and has NOT filed Form 5768(election under section 501(h)).

(b)

Yes No Amount

1 During the year, did the filing organization attempt to influence foreign, national, state or locallegislation, including any attempt to influence public opinion on a legislative matter or referendum,through the use of

a Volunteers

b Paid staff or management (include compensation in expenses reported on lines 1 c through 11)7

c Media advertisements?

d Mailings to members, legislators, or the public?

e Publications, or published or broadcast statements?

f Grants to other organizations for lobbying purposes?

g Direct contact with legislators, their staffs, government officials, or a legislative body?

h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means7

i Other activities? If 'Yes,' describe in Part IV

j Total. Add lines 1c through 1i

2a Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? _

b If 'Yes,' enter the amount of any tax incurred under section 4912

c If 'Yes,' enter the amount of any tax incurred by organization managers under section 4912

d If the filing organization incurred a section 4912 tax, did it file Form 4720 for this ear?

Part Ill-A Complete if the organization is exempt under section 501(cX4), section 501(cX5), or section 501(cx6).

Yes No

1 Were substantially all (90% or more) dues received nondeductible by members? 1 X

2 Did the organization make only in-house lobbying expenditures of $2,000 or less? 2 X

3 Did the organization agree to carryover lobby ing and political expenditures from the prior ear? 3 X

Part Ill-B I Complete if the organization is exempt under section 501(cX4), section 501 (cX5), or section 501(cX6)if BOTH Part III-A, questions 1 and 2 are answered 'No' OR if Part III -A, line 3 is answered 'Yes.'

1 Dues, assessments and similar amounts from members 1

2 Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of politicalexpenses for which the section 527(f) tax was paid).

a Current year 2a

b Carryover from last year 2b

c Total 2c

3 Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues 3

4 If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excessdoes the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political --expenditure next year? 4

5 Taxable amount of lobby ing and p olitical ex penditures (see instructions) 5

Part IV Su pplemental Information

Complete this part to provide the descriptions required for Part I-A, line 1, Part I-B, line 4, Part I-C, line 5, and Part II-B, line 11Also, complete this part for any additional information--------------------------------------------------------------------

BAA Schedule C (Form 990 or 990-EZ) 2009

TEEA3203 02/05/10

Schedule C ( Form 990 or 990-EZ ) 2009District 1199 NW, Hosp ital & Health Care Emp . Union , SEIU, AFL - CIO 91-1275780 Page 4

Part IV Supplemental Information (continued)

BAA Schedule C (Form 990 or 990-EZ) 2009

TEEA3204 07/17/09

SCHEDULE D(Form 990) Supplemental Financial Statements

► Complete if the organization answered ' Yes,' to Form 990,

Department of the Treasury Part IV , lines 6 , 7, 8, 9, 10 , 11, or 12.Internal Revenue Service ► Attach to Form 990. ► See separate instructions

Name

0M8 No 1545.0047

2009Open to PublicInspection

Employer Identification number

District 1199 NW, Hospital & Health Care Emp. Union, SEIU, AFL-CIO 191-1275780

I Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts Complete ifthe organization answered 'Yes' to Form 990, Part IV, line 6.

(a ) Donor advised funds ( b) Funds and other accounts

1 Total number at end of year

2 Aggregate contributions to (during year)

3 Aggregate grants from (during year)

4 Aggregate value at end of year

5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advisedfunds are the organization ' s property , subject to the organization ' s exclusive legal control? E]Yes [ No

6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may beused only for charitable purposes and not for the benefit of the donor or donor advisor or for any otherpurpose conferring impermissible private benefit?E ]Yes [ No

Part II Conservation Easements Complete if the organization answered 'Yes' to Form 990, Part IV, line 7.

1 Purpose (s) of conservation easements held by the organization (check all that apply)

Preservation of land for public use (e g , recreation or pleasure ) Preservation of an historically important land area

Protection of natural habitat Preservation of certified historic structure

Preservation of open space

2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on thelast day of the tax year.

Held at the End of the Year

a Total number of conservation easements 2a

b Total acreage restricted by conservation easements 2b

c Number of conservation easements on a certified historic structure included in (a) 2c

d Number of conservation easements included in (c) acquired after 8/17/06 2d

3 Number of conservation easements modified , transferred, released , extinguished , or terminated by the organization during the tax

year ►4 Number of states where property subject to conservation easement is located ►

5 Does the organization have a written policy regarding the periodic monitoring , inspection, handling of violations,and enforcement of the conservation easement it holds? El Yes r] No

6 Staff and volunteer hours devoted to monitoring , inspecting , and enforcing conservation easementsduring the year ►

7 Amount of expenses incurred in monitoring , inspecting , and enforcing conservation easementsduring the year ► $

8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section170(h)(4)(B)(i) and 170(h)(4)(B)(II)? F] Yes No

9 In Part XIV , describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, andinclude , if applicable , the text of the footnote to the organization ' s financial statements that describes the organization ' s accounting forconservation easements

Part III Organizations Maintaining Collections of Art , Historical Treasures, or Other Similar AssetsComplete if the organization answered 'Yes' to Form 990, Part IV, line 8.

1 a If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of art, historicaltreasures , or other similar assets held for public exhibition , education , or research in furtherance of public service , provide, in Part XIV,the text of the footnote to its financial statements that describes these items

b If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art, historicaltreasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the followingamounts relating to these items

(i) Revenues Included in Form 990, Part VIII, line 1 ► $

(ii) Assets Included in Form 990, Part X ► $

2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the followingamounts required to be reported under SFAS 116 relating to these items

a Revenues Included in Form 990, Part VIII, line 1 ► $

b Assets Included in Form 990, Part X ► $

BAA For Privacy Act and Paperwork Reduction Act Notice , see the Instructions for Form 990 . Schedule D (Form 990) 2009

TEEA3301 02/02/10

Schedule D (Form 990) 2009 District 1199 NW , Hospital & Health Care Hmp. Union, sale, APL-CIO 91-1275780 Page 2

Part III Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets (continued)

3 Using the organization's acquisition accession and other records, check any of the following that are a significant use of its collectionitems (check all that apply)

a Public exhibition d B Loan or exchange programs

b Scholarly research e Other

c Preservation for future generations

4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose inPart XIV

5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similarassets to be sold to raise funds rather than to be maintained as part of the organization's collections Yes No

Part IV Escrow and Custodial Arrangements Complete if organization answered 'Yes' to Form 990, Part IV, line9, or reported an amount on Form 990, Part X, line 21.

1 a Is the organization an agent , trustee , custodian , or other intermediary for contributions or other assets notincluded on Form 990 , Part X' 11 Yes No

b If 'Yes,' explain the arrangement in Part XIV and complete the following table

Amount

c Beginning balance 1 c

d Additions during the year 1 d

e Distributions during the year 1 e

f Ending balance if

2a Did the organization include an amount on Form 990, Part X, line 21 ? 1-1 Yes No

b If 'Yes,' ex p lain the arrangement in Part XIV

Part V Endowment Funds Com p lete if org anization answered 'Yes' to Form 990, Part IV, line 10.

1 a Beginning of year balance

b Contributions

c Net Investment earnings, gains,and losses

d Grants or scholarships

e Other expenditures for facilitiesand programs

f Administrative expenses

g End of year balance

(a ) Current year (b ) Prior year (c) Two years back (d) Three years back (e) Four years back

Provide the estimated percentage of the year end balance held as

a Board designated or quasi-endowment ► %

b Permanent endowment ► %

c Term endowment 1, %

3a Are there endowment funds not in the possession of the organization that are held and administered for theorganization by Yes No

(i) unrelated organizations 3a i

(ii) related organizations 3a ii

b If 'Yes' to 3a(ii), are the related organizations listed as required on Schedule R' 3b

4 Describe in Part XIV the intended uses of the organization's endowment funds

Part VI Investments-Land , Buildings , and Equipment . See Form 990, Part X, line 10.Description of investment (a) Cost or other basis

(investment)(b) Cost or otherbasis (other)

(c) AccumulatedDep reciation

(d) Book Value

1 a Land

b Buildings

c Leasehold improvements

d Equipment

e Other 426, 363. 310, 783. 115, 580.

Total . Add lines 1 a throug h 1 e (Column (d) must equal Form 990, Part X, column (B) , line 10(c) 115,580.BAA Schedule D (Form 990) 2009

TEEA3302 02102/10

Schedule D (Form 990) 2009 District 1199 NW , Hospital & Health Care Emp. Union , SHIU , AFL-CIO 91-1275780 Page 3

Part VII Investments-Other Securities See Form 990, Part X, line 12.(a) Description of security or category (b) Book value (c) Method of valuation

(including name of securit Cost or end-of - year market value

Financial derivatives

Closely- held equity interests

Other------------------------

----------------------------

----------------------------

----------------------------

----------------------------

----------------------------

----------------------------

----------------------------

----------------------------

----------------------------Total . (Column (b) must a ual Form 990 Part X, col. (B) line 12) 1, 1

Part VilI Investments-Prog ram Related (See Form 990 , Part X , line 13 )

(a) Description of investment typeI I

(b) Book value (c) Method of valuationCost or end -of-year market value

Total. (Column b must a ual Form 990, Part X, Col (B) line 13

Part IX Other Assets (See Form 990, Part X, line 15)(a) Descri ption (b) Book value

Advances 14,429.

Security deposits 21,108.

Total . (Column (b) must equal Form 990, Part X, col (B), line 15)

Part X Other Liabilities (See Form 990, Part X, line 25)(a) Descri p tion of Liability (b) Amount

Federal Income Taxes

1 35,537.

Total (Column (b) must equal Form 990, Part X, col (B) line 25) ► 1 12. FIN 48 Footnote In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liabilityfor uncertain tax positions under FIN 48

BAA TEEA3303 o2/o2no Schedule D (Form 990) 2009

Schedule D (Form 990) 2009 District 1199 NW , Hospital & Health Care Emp. Union , SEIU, AFL-CIO 91-1275780 Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements1 Total revenue (Form 990, Part VII I,column (A), line 12) 12,101,586.

2 Total expenses (Form 990, Part IX, column (A), line 25) 10, 518, 958.

3 Excess or (deficit) for the year. Subtract line 2 from line 1 1,582,628.

4 Net unrealized gains (losses) on investments - 14,409.

5 Donated services and use of facilities

6 Investment expenses

7 Prior period adjustments

8 Other (Describe in Part XIV)

9 Total adjustments (net) Add lines 4 through 8 -14,409.

10 Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9 1,568,219.

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

1 Total revenue, gains, and other support per audited financial statements 1 12,087,177.

2 Amounts included on line 1 but not on Form 990, Part VIII, line 12

a Net unrealized gains on investments 2a -14,409.

b Donated services and use of facilities 2b

c Recoveries of prior year grants 2c

d Other (Describe in Part XIV) 2d

e Add lines 2a through 2d 2e -14,409.

3 Subtract line 2e from line 1 3 12, 101, 586.

4 Amounts included on Form 990, Part VIII, line 12, but not on line 1

a Investments expenses not included on Form 990, Part VIII, line 7b 4a

b Other (Describe in Part XIV) 4b

c Add lines 4a and 4b 4c

5 Total revenue Add lines 3 and 4c. (This must eq ual Form 990, Part I, line 12) 5 12, 101,586.

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return1 Total expenses and losses per audited financial statements 1 10,518,958.

2 Amounts included on line 1 but not on Form 990, Part IX, line 25

a Donated services and use of facilities 2a

b Prior year adjustments 2b

c Other losses 2c

d Other (Describe in Part XIV) 2d

e Add lines 2a through 2d 2e

3 Subtract line 2e from line 1 3 10 , 518,958.

4 Amounts included on Form 990, Part IX, line 25, but not on line 1:

a Investments expenses not included on Form 990, Part VIII, line 7b 4a

b Other (Describe in Part XIV) 4b

c Add lines 4a and 4b 4c

5 Total ex penses Add lines 3 and 4c (This must eq ual Form 990, Part I, line 18 ) 5 10,518,958.

Part XIV Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9, Part III, lines 1a and 4, Part IV, lines 1b and 2b, Part V,line 4, Part X, line 2, Part XI, line 8, Part XII, lines 2d and 4b, and Part XIII, lines 2d and 4b Also complete this part to provide any additionalinformation

BAA TE304 ovo2no Schedule D (Form 990) 2009

Schedule D (Form 990) 2009 District 1199 NW , Hospital & Health Care Emp. Union , 9810 . AFL -CIO 91-1275780 Page 5

Part XIV Supplemental Information (continued)

BAA TEEA3305 07/10/09 Schedule D (Form 990) 2009

SCHEDULE 0(Form 990)

Department of the TreasuryInternal Reve nue Service

Name of the organization

Supplemental Information to Form 990

Complete to provide information for responses to specific questions onForm 990 or to provide any additional information.

► Attach to Form 990.

OMB No 1545 0047


Inspection

Employer identification number

91-1275780

Pt -VI-A, Line 6 Dues a in members of the labor union.

Pt -VI-A, Line 7a The members elect- the- three full time paid officers,_

_ _ _ _ _ _ _ _ _ _ _ _ _ _president, secretary.- treasurer, .executive vice president-------- -----------------

______________and two rank and file-vice Pre s i dent s- - - - - - - -----------------------

Pt VI-A, Line 7b By-law changes and rate chances are approved--------------- -- ------- -----------------

______________by the membership,-----.----------------------------------

PtVI-A, Line 8b The Local does not have any committees with the-------------------------------- ---- -------------------------

- - - - - - - - - - - - - - authority _to act on behalf of the governin,7c body_____________

Pt -VI-B, Line 11A The president_and_secretary- treasurer both review

______________the Form 990_fo amaterial omissions-or misstatements---------------------•

_ _____________ prior to filin the tax return.

Pt VI-B, Line 12c The Local intends to have the conflict of interest

-------------- formaundated-annually_------------------------------------•

Pt VI-C, Line 19 The Local makes their financial information available------------------------------------------------------------------

______________ to union members u on re eat.------------q ---qu----------------------------------

BAA For Privacy Act and paperwork Reduction Act Notice , see the instructions for Form 990 TEEA4901 07/17/09 Schedule 0 (Form 990) 2009

Form 4562-Department of the TreasuryIntern al Reve n ue Service I

Depreciation and Amortization(Including Information on Listed Property)

► See separate in ► Attach to your tax return.

OMB No 1545-0172

2009Attachment c7Sequence No y

Name (s) shown on return Identifying number

District 1199 NW , Hospital & Health Care Emp. Union , SEIU , AFL-CIO 91-1275780

Business or activity to which this form relates

Form 990 / Form 990EZ

Part I Election To Expense Certain Property Under Section 179Note : If you have any listed property, complete Part V before you complete Part 1.

1 Maximum amount See the instructions for a higher limit for certain businesses 1 $250, 000.

2 Total cost of section 179 property placed in service (see instructions) 2

3 Threshold cost of section 179 property before reduction in limitation (see instructions) 3 $800,000.

4 Reduction in limitation. Subtract line 3 from line 2 If zero or less, enter -0- 4

5 Dollar limitation for tax year Subtract line 4 from line 1. If zero or less, enter -0- If married filingseoarately. see instructions 5

6 of

7 Listed property Enter the amount from line 29 I 7 I

8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7

9 Tentative deduction Enter the smaller of line 5 or line 8

10 Carryover of disallowed deduction from line 13 of your 2008 Form 4562

11 Business income limitation Enter the smaller of business income (not less than zero) or line 5 (see instrs)

12 Section 179 expense deduction Add lines 9 and 10, but do not enter more than line 11

13 Carryover of disallowed deduction to 2010 Add lines 9 and 10, less line 12 ► 13

Note : Do not use Part ll or Part 111 below for listed property Instead, use Part V

Part II Special Depreciation Allowance and Other Depreciation (Do not include listed prope instructions

14 Special depreciation allowance for qualified property (other than listed property) placed in service during thetax year (see instructions) 14

15 Property subject to section 168(f)(1) election 15

16 Other de p reciation ( includin g ACRS) 16 39,337.

Part III MACRS Depreciation (Do not include listed p ro p erty (See instructions )

Section A

17 MACRS deductions for assets placed in service in tax years beginning before 2009 17

18 If you are electing to group any assets placed in service during the tax year into one or more generalasset accounts, check here ►

Section B - Assets Placed in Service During 2009 Tax Year Using the General Deoreciation System

(a)Classification of property

(b) Month andyear placedin service

(C) Basis for depreciation( business/investment useonly - see instructions)

(d)

Recovery period(e)

Convention(f)

Method(9) Deprec i ation

deduction

19a 3 • ear prop erty

b 5 -year prop erty

c 7- year prop erty

d 10 ear p rop erty

e 15 ear p rop erty

f 20 ear p rop erty

25 ear p rop erty 25 yrs S/L

h Residential rental 27.5 yrs MIA S/Lproperty 27.5 yrs MM S/L

i Nonresidential real 39 yrs MM S/Lproperty MM S/L

Section r - Accets Plared in Service DIurino 2n0Q Tay Year I vino the Alternative Denrerintion Svctem

20a Class life S/L

b 12-ear 12 yrs S / L

c 40-year 40 yrs MM S/L

S21 Listed property Enter amount from line 28 21

22 Total Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21 Enter here and onthe appropriate lines of your return Partnerships and S corporations - see instructions 22 39,337.

23 For assets shown above and placed in service during the current year, enterthe portion of the basis attributable to section 263A costs 23

BAA For Paperwork Reduction Act Notice , see separate instructions . FDIZ0812 07/07/09 Form 4562 (2009)

Form 4562 (2009) District 1199 NW, Hos p ital & Health Care Emp . Union , SEIU , AFL-CIO 91-1275780 Page 2

Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used forentertainment, recreation, or amusement )

Note : For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b,columns (a) through (c) of Section A, all of Section B, and Section C if applicable

Section A - Dep reciation and Other Information (Caution : See the instructions for limits for passenger automobiles. )

I'gds nn vnii have evidence to siunnnrt the hiisiness/investment lisp clalmed7 YPC N. 246 If 'Yes ' is the evidence written? Yec 11 No

(a) (b) (c) (d) (e) (f) (g) (h) (i)Type of property (list Date placed Business/

investment Cost or Basis for depreciation Recovery Method/ Depreciation Electedvehicles first) in service other basis (business/investment period Convention deduction section 179

use use only) costoercentage

25 Special depreciation allowance for qualified listed property placed in service during the tax year andused more than 50% Ina q ualified business use (see instructions ) 25

28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 28

29 Add amounts in column (I), line 26 Enter here and on line 7, page 1 29

Section B - Information on Use of Vehicles

Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person. If you provided vehiclesto your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles

(a) (b) (c) (d) (e) (f)30 Total business/Investment miles driven Vehicle 1 Vehicle 2 Vehicle 3 Vehicle 4 Vehicle 5 Vehicle 6during the year (do not include

commuting miles)

31 Total commuting miles driven during the year

32 Total other personal (noncommuting)miles driven

33 Total miles driven during the year Addlines 30 through 32

Yes No Yes No Yes No Yes No Yes No Yes No

34 Was the vehicle available for personal useduring off-duty hours?

35 Was the vehicle used primarily by a morethan 5% owner or related person?

36 Is another vehicle available forp ersonal use?

Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees

Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than5% owners or related persons (see instructions).

37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, •Yes No

by your employees?

38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by youremployees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners

39 Do you treat all use of vehicles by employees as personal use?

40 Do you provide more than five vehicles to your employees, obtain information from your employees about the use of thevehicles, and retain the information received?

41 Do you meet the requirements concerning qualified automobile demonstration use? (See Instructions )N ote : If your answer to 37, 38, 39, 40, or 41 is 'Yes,' do not complete Section B for the covered vehicles

Part VI I Amortization

(a) (b) (c) (d) (e) (f)Description of costs Date amortization Amortizable Code Amortization Amortization

begins amount section period or for this yearpercentage

42 Amortization of costs that bealns durina your 2009 tax year (see instructions)

43 Amortization of costs that began before your 2009 tax year 43

44 Total. Add amounts in column (f) See the instructions for where to report 44

FDIZ0812 07/07/09 Form 4562 (2009)

27 ProDertv used 50% or less in a aualified business use-

f, • . .District 1199 NW, Hospital & Health Care Emp Union, SEIU, AFL-CIO 91-1275780

Schedule 0 (Form 990), Supplemental Information to Form 990

Form 990, Page 2 , Part III, Line 1 (continued)

Briefly describe the organization's mission:

technologists , mental health clinicians , professionals , therapist , certified nursing

aids and other kinds of health care workers.

Documents

Return of Organization ExemptFromIncomeTax990s.foundationcenter.org/990_pdf_archive/911/... · r • 990 OMBNo 1545-0047 Form Return of Organization ExemptFromIncomeTax Undersection