2017-03-30T16:52:42-05:00 2016-08-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2015-09-01 946667029 CALIFORNIA TEACHERS ASSOC EMPLOYEES' HEALTH AND WELFARE BENEFITS TRUST CALI 5032825581 PO BOX 4148 PORTLAND OR 97208 DAVID GOLDBERG TRUSTEE 5032825581 2017-03-30 1 KATHLEEN D HAAB P01068129 9252779100 2015 2021-01-29 14:40:06Z DAVID GOLDBERG PO BOX 4148 PORTLAND OR 97208 27802202 0 X N/A X 1993 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 8 0 0 0 0 0 0 0 23459879 24508247 682900 315899 0 0 24142779 24824146 0 0 21342515 20148545 0 0 0 0 0 1820834 1768651 23163349 21917196 979430 2906950 16692606 19847468 1729698 1513086 14962908 18334382 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE ACTIVE AND RETIRED PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 6 0 1 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X WC EARHART COMPANY INC 5032825581 3140 NE BROADWAY STREET PORTLAND OR 97232 X DAVID GOLDBERG CO-CHAIRMAN 3.00 X 0 0 0 JOE NUNEZ TRUSTEE 2.00 X 0 0 0 RANNY KRAVETZ TRUSTEE 2.00 X 0 0 0 JAKE ANDERSON TRUSTEE 2.00 X 0 0 0 JOHN STEPHENS JR CHAIRMAN 3.00 X 0 0 0 WANDA TURNER TRUSTEE 2.00 X 0 0 0 CHUCK KING TRUSTEE 2.00 X 0 0 0 ERIC HEINS TRUSTEE 3.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 X 0 1 0 0 1 0 0 0 0 0 ANTHEM BLUE CROSS OF CALIFORNIA 801 S FIGUEROA STREET 5TH FLOOR LOS ANGELES CA 90017 CLAIMS ADMINISTRATION 765226 THE WILLIAM C EARHART COMPANY PO BOX 4148 PORTLAND OR 97208 CONTRACT ADMINISTRATION 240474 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DR MIAMI FL 33156 CONSULTING 190511 3 EMPLOYER CONTRIBUTIONS 900099 24282238 24282238 EGWP DIRECT SUBSIDY 900099 93581 93581 PARTICIPANT CONTRIBUTI 900099 60605 60605 RETIREE MEDICARE SUBSI 900099 43434 43434 HCV PROGRAM REIMBURSEM 900099 28389 28389 24508247 385612 385612 2908343 2978056 -69713 -69713 -69713 24824146 24508247 0 315899 20148545 216300 58623 68349 25000 1197957 92390 15194 12739 47863 ACA REINSURANCE FEE 34236 21917196 1969122 4380684 9722 9756 2089433 2055762 26420 22965 12597909 13378301 16692606 19847468 209298 199986 1520400 1313100 1729698 1513086 X 0 0 0 0 14962908 18334382 14962908 18334382 16692606 19847468 2906950 464524 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 1313100 1313100 X 25263670 464524 464524 24799146 25000 25000 24824146 22099496 0 22099496 25000 -207300 -182300 21917196 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 POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF AUGUST 31, 2016, 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 2013. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH W.C. EARHART COMPANY, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. THE BOARD REVIEWED THE FORM 990 WITH THE ADMINISTRATIVE MANAGER. FORM 990, PART VI, SECTION B, LINE 12C IF AND WHEN A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE CONFLICT-OF-INTEREST OFFICER (ORGANIZATION'S LEGAL COUNSEL) WILL EVALUATE IF THE MATTER WOULD LIKELY PREVENT AN UNBIASED OR OBJECTIVE DECISION BY A TRUSTEE AND, AS APPROPRIATE, DISCLIPINARY OR CORRECTIVE ACTION WILL BE TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT-OF-INTEREST POLICY 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 ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, W.C. EARHART COMPANY, INC. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CALIFORNIA TEACHERS ASSOCIATION EMPLOYEES RETIREMENT BENEFITS 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 680427229 TO PROVIDE RETIREMENT BENEFITS CA 501(A) N/A N/A 0 CALIFORNIA TEACHERS ASSOCIATION 1705 MURCHISON DRIVE BURLINGAME CA 94010 940362310 TO PROMOTE WELL-BEING OF MEMBERS CA 501(C)(5) N/A N/A 0 CALIFORNIA ASSOCIATE STAFF 1118 10TH STREET SACRAMENTO CA 95817 510181184 LABOR ORGANIZATION CA 501(C)(5) N/A N/A 0 CALIFORNIA STAFF ORGANIZATION INC 12210 WATERBROOK DRIVE RANCHO CUCAMONGA CA 91739 954497350 LABOR ORGANIZATION CA 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE 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 AUGUST 31, 2016, THERE ARE APPROXIMATELY 42 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 NAME OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. ALAMEDA EDUCATION ASSN ALHAMBRA TEACHERS ASSN ANAHEIM EDUCATORS ASSOCIATED CHINO THRS ASSOCIATED POMONA THRS CTA- STAFF CALIFORNIA FACULTY ASSN CALIFORNIA RETIRED THRS CAPISTRANO UNIF EDUC ASSN CITRUS BELT UNISERV CORONA NORCO TEACHERS ASSN FONTANA TEACHERS ASSN FREMONT UNIFIED TEACHERS FRESNO TEACHERS ASSN GARDEN GROVE EDUC ASSN LOS ANGELES - CEA MONTEBELLO TEACHERS ASSN MT HAMILTON CTA/NEA NORTH ORANGE CTY UTD THRS OAKLAND EDUCATION ASSN ONTARIO-MONTCLAIR TEACHERS ORANGE UNIFIED EDUCATION PUENTE HILLS UNISERV RANCHO CERRITOS UNTD THRS RIALTO EDUCATION ASSN RIVERSIDE CITY TEACHERS SACRAMENTO CITY THRS ASSN SAN BERNARDINO THRS ASSN SAN DIEGO EDUC ASSN SAN JUAN THRS ASSN SAN MATEO THRS ASSN SANTA ANA EDUCATORS ASSN SOUTH BAY UNITED THRS SOUTH COUNTY TCHERS UNITED STOCKTON TEACHERS ASSN THRS ASSN OF LONG BEACH TORRANCE TEACHERS ASSN TRI-CITY EDUCATORS ASSN TWIN LAKES UNISERV UNITED THRS OF RICHMOND WEST ORANGE CTY UNITED WHITTIER SECONDARY EDUC