2016-03-31T15:26:11-05:00 2015-08-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2014-09-01 946667029 CALIFORNIA TEACHERS ASSOC EMPLOYEES' HEALTH AND WELFARE BENEFITS TRUST CALI 5032825581 PO BOX 4148 PORTLAND OR 97208 DAVID GOLDBERG TRUSTEE 5032825581 2016-03-31 1 KATHLEEN D HAAB P01068129 9252779100 2014 2016-08-17 19:52:53Z DAVID GOLDBERG PO BOX 4148 PORTLAND OR 97208 30729406 0 X N/A X 1993 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 9 0 0 0 0 0 0 0 20113919 23459879 657528 682900 19281 0 20790728 24142779 0 0 19902764 21342515 0 0 0 0 0 1735047 1820834 21637811 23163349 -847083 979430 16816108 16692606 1722011 1729698 15094097 14962908 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 9 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 DEAN VOGEL TRUSTEE - PAST 2.00 X 0 0 0 JOE NUNEZ TRUSTEE 2.00 X 0 0 0 KATIE MULLINS TRUSTEE - PAST 2.00 X 0 0 0 JAKE ANDERSON TRUSTEE 2.00 X 0 0 0 AMIHAN MAKAYAN TRUSTEE - PAST 2.00 X 0 0 0 JOHN STEPHENS JR CHAIRMAN 3.00 X 0 0 0 CHUCK KING TRUSTEE 2.00 X 0 0 0 ERIC HEINS TRUSTEE 3.00 X 0 0 0 WANDA TURNER TRUSTEE 2.00 X 0 0 0 DAVID GOLDBERG CO-CHAIRMAN 3.00 X 0 0 0 RANNY KRAVETZ TRUSTEE 2.00 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 759024 THE WILLIAM C EARHART COMPANY PO BOX 4148 PORTLAND OR 97208 CONTRACT ADMINISTRATION 217797 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DR MIAMI FL 33156 CONSULTING 194669 3 EMPLOYER CONTRIBUTIONS 900099 23061255 23061255 RETIREE MEDICARE SUBSI 900099 353072 353072 PARTICIPANT CONTRIBUTI 900099 45552 45552 23459879 424233 424233 6845294 6586627 258667 258667 258667 24142779 23459879 0 682900 21342515 210000 54813 69811 25000 1198298 71391 13831 34322 38841 ACA REINSURANCE FEE 99665 OTHER EXPENSES 4862 23163349 1204588 1969122 5538 9722 1279995 2089433 16175 26420 14309812 12597909 16816108 16692606 191911 209298 1530100 1520400 1722011 1729698 X 0 0 0 0 15094097 14962908 15094097 14962908 16816108 16692606 979430 -1110619 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 1520400 1520400 X 23007160 -1110619 -1110619 24117779 25000 25000 24142779 23148049 0 23148049 25000 -9700 15300 23163349 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, 2015, 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 2012. 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 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, 2015, THERE ARE APPROXIMATELY 44 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. ALAMEDA EDUCATION ASSN ALHAMBRA TEACHERS ASSN ANAHEIM EDUCATORS ASSOCIATED CHINO THRS ASSOCIATED POMONA THRS BLOSSOM RIDGE UNISERV CALIFORNIA FACULTY ASSN CALIFORNIA RETIRED THRS CAPISTRANO UNIF EDUC ASSN CITRUS BELT UNISERV CORONA NORCO TEACHERS ASSN CTA- STAFF 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 UTD EDUCATORS OF SAN FRANCISCO WEST ORANGE CTY UNITED WHITTIER SECONDARY EDUC