2022-11-15T09:01:38-06:00 2021-12-31 222027092 WITHUMSMITHBROWN PC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2021-01-01 936024141 OREGON LABORERS - EMPLOYERS HEALTH & WELFARE TR FUND OREG 5032825581 12029 NE GLENN WIDING DR PORTLAND OR 97220 JEFF GRITZ TRUSTEE 5032825581 2022-11-15 1 JEFF GRITZ 999009999 JAMES N BROWNING P01451906 9252779100 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JEFF GRITZ 17230 NE SACRAMENTO ST 201 PORTLAND OR 97230 89680656 0 X N/A X 1954 OR PROVIDE HEALTH AND WELFARE BENEFITS 6 1 0 0 0 0 0 0 41087555 37543923 326829 910844 0 0 41414384 38454767 0 0 29120585 29183584 0 0 0 0 0 2532715 2398540 31653300 31582124 9761084 6872643 41505382 48314268 15364011 15133418 26141371 33180850 PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 4 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 X WC EARHART CO 5032825581 12029 NE GLENN WIDING DR PORTLAND OR 97220 X JEFF GRITZ TRUSTEE 0.50 X 0 0 0 ZACK CULVER TRUSTEE 0.50 X 0 0 0 JAMES R WATTS TRUSTEE 0.50 X 0 0 0 KELLY DIXON TRUSTEE 0.50 X 0 0 0 BOB TIMMONS TRUSTEE 0.50 X 0 0 0 BEN NELSON TRUSTEE 0.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATI 1.00 X 0 1 0 0 1 0 0 0 0 0 REGENCE BLUE CROSS BLUE SHIELD 100 SW MARKET STREET PORTLAND OR 972015702 CLAIMS ADMINISTRATION 1280572 WILLIAM C EARHART CO INC PO BOX 4148 PORTLAND OR 97208 THIRD PARTY ADMINISTRATIVE FEES 326485 OREGON LABORERS-EMPLOYERS ADMIN LLC 12029 NE GLENN WIDING DR PORTLAND OR 97220 COORDINATOR EXPENSE 190676 MILLIMAN INC 1455 SW BROADWAY ST STE 1600 PORTLAND OR 97201 CONSULTING 134763 4 EMPLOYER CONTRIBUTIONS 900099 34511831 34511831 PARTICIPANT CONTRIBUTIONS 900099 1615404 1615404 PRESCRIPTION REBATES 900099 1194650 1194650 COBRA SUBSIDY 900099 113735 113735 MEDICARE PART D SUBSIDY 900099 108303 108303 37543923 902862 902862 51233871 51225889 7982 7982 7982 38454767 37543923 0 910844 29183584 311720 95415 57750 116375 1606011 78081 550 43160 NAT'L HEALTH AND SAFETY 89478 31582124 501534 727606 3501089 3888223 875 3427 26134009 24072572 11367875 19622440 41505382 48314268 392011 440418 14972000 14693000 15364011 15133418 X 0 0 0 0 26141371 33180850 26141371 33180850 41505382 48314268 6872643 166836 0 X X 0 1 X 1 0 0 COMMON/COLLECTIVE TRUST FUNDS 19622440 F 19622440 ACCUMULATED ELIGIBILITY CREDITS 11873000 CLAIMS PAYABLE AND IBNR 2820000 14693000 X 38505228 166836 166836 38338392 116375 116375 38454767 31744749 0 31744749 116375 -279000 -162625 31582124 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMBER 31,2021, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2018. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH WILLIAM C. EARHART CO., INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B ALL MEMBERS OF THE BOARD OF TRUSTEES REVIEWED THE FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, WILLIAM C. EARHART. CO. FORM 990, PART XII , LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSIGHT OF THE ANNUAL AUDIT AND FOR SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OREGON LABORERS - EMPLOYERS PENSION PLAN 12029 NE GLENN WIDING DR PORTLAND OR 97220 936075363 TO PROVIDE PENSION BENEFITS OR 501(A) N/A N/A 0 OREGON LABORERS-EMPLOYERS DEFINED CONTRIBUTION AND 401(K) PLAN 12029 NE GLENN WIDING DR PORTLAND OR 97220 276434385 TO PROVIDE PENSION BENEFITS OR 501(A) N/A N/A 0 OREGON AND SOUTHERN IDAHO LABORERS - EMPLOYERS TRAINING TRUST 12029 NE GLENN WIDING DR PORTLAND OR 97220 204626312 TO PROVIDE TRAINING BENEFITS OR 501(C)3 N/A N/A 0 OREGON AND SOUTHERN IDAHO DISTRICT COUNCIL OF LABORERS 17230 NE SACRAMENTO ST 201 PORTLAND OR 97230 930144236 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 LABORERS INTERNATIONAL UNION LOCAL 483 1125 SE MADISON ST SUITE 206 PORTLAND OR 97214 930169132 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 LABORERS LOCAL 737 17230 NE SACRAMENTO ST 201 PORTLAND OR 97230 474408911 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 LABORERS UNION LOCAL 155 465 W 17TH ST IDAHO FALLS ID 83402 820411490 LABOR ORGANIZATION ID 501(C)5 N/A N/A 0 OREGON LABORERS ADMINISTRATIVE LLC 12029 NE GLENN WIDING DR PORTLAND OR 97220 830431313 ADMINISTRATIVE SERVICES OR NA - THERE ARE 3 EQUAL PARTNERS RELATED 144095 0 0 0.33330 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 OREGON LABORERS ADMINISTRATIVE LLC M 190676 OBTAINED FROM THE PLAN'S RECORDS. SCHEUDLE R - IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF DECEMBER 31, 2021, THERE ARE APPROXIMATELY 282 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. 3 KINGS ENVIRONMENTAL INC A B UTILITY CONTRACTORS A&D FLAGGING LLC ABERCROMBIE PIPELINE ACCESS LIMITED CONST. 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