2014-10-10T13:29:29-05:00 2014-01-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2013-02-01 956035137 PRINTING SPECIALTIES AND PAPER PRODUCTS JOINT EMPLOYER & UNION H & W FUND PRIN 2067263251 2323 EASTLAKE AVENUE EAST SEATTLE WA 98102 STEPHEN E NORTHUP TRUSTEE 2067263251 2014-10-10 1 KATHLEEN HAAB P01068129 9252779100 2013 2015-11-30 17:44:51Z STEPHEN E NORTHUP 2323 EASTLAKE AVENUE E SEATTLE WA 98102 71570906 0 X N/A X 1952 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. 6 1 1 0 0 0 0 0 57789688 57166761 956646 995666 90902 13331 58837236 58175758 0 0 59741615 59506984 0 0 0 0 0 2024904 1933875 61766519 61440859 -2929283 -3265101 78082752 74930060 14483721 14959214 63599031 59970846 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 2839 0 1 1 1 0 0 0 0 0 0 X 6 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X NORTHWEST ADMINISTRATORS INC 2063294900 2323 EASTLAKE AVE EAST SEATTLE WA 981023305 X LEASHA BAILEY TRUSTEE 1.00 X 0 0 0 CLARK RITCHEY TRUSTEE 1.00 X 0 0 0 GAYLE SPARAPANI TRUSTEE & SECRETARY 1.00 X 0 0 0 STEPHEN E NORTHUP TRUSTEE & CHAIRMAN 1.00 X 0 0 0 TOM JOLLEY TRUSTEE 1.00 X 0 0 0 DAN CABADA TRUSTEE 1.00 X 0 0 0 CHARLES RUBLE III TRUSTEE - PAST 1.00 X 0 0 0 SEE SCHED O FOR COMPENSATION PAID BY RELATED ORGANIZATION 1.00 X 0 1 0 0 1 0 0 0 0 0 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVE EAST SEATTLE WA 981023305 CONTRACT ADMINISTRATOR 711984 BLUE SHIELD OF CALIFORNIA 2175 N CALIFORNIA AVE STE 250 WALNUT CREEK CA 94596 CLAIMS ADMINISTRATOR 236342 DONALDSON & CORNWELL 1017 EAST GRAND AVENUE ESCONDIDO CA 92025 ATTORNEY 212374 LINDQUIST LLP 9725 3RD AVE NE STE 603 SEATTLE WA 98115 ACCOUNTANT 163315 BANK OF AMERICA 121 SW MORRISON STREET PORTLAND OR 98207 INVESTMENT MGR AND BANKING 155855 6 EMPLOYER CONTRIBUTIONS 900099 55119604 55119604 STOP LOSS REIMBURSEMENTS 900099 1303588 1303588 SELF-PAY CONTRIBUTIONS 900099 453600 453600 PRESCRIPTION REBATE 900099 289969 289969 57166761 1372969 1372969 13017845 13395148 -377303 -377303 -377303 LIQUIDATED DAMAGES & INTEREST 900099 12760 12760 OTHER INCOME 900099 571 571 13331 58175758 57180092 0 995666 59506984 712838 209296 133314 235489 424383 148713 31752 38090 61440859 5406907 5726111 5149043 4639760 34916 34916 22257410 21978718 45234476 42550555 78082752 74930060 687748 836214 13795973 14123000 14483721 14959214 X 0 0 0 0 63599031 59970846 63599031 59970846 78082752 74930060 -3265101 -363084 0 X X 0 1 X 1 0 0 BANK OF AMERICA SHORT DURATION VEBA AND 501(C) COMMON TRUST FUND 42550555 F 42550555 ACCUMULATED ELIGIBILITY CREDITS 9608000 CLAIMS PAYABLE AND IBNR 4515000 14123000 X 57577185 -363084 -363084 57940269 235489 235489 58175758 60878343 0 60878343 235489 327027 562516 61440859 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 JANUARY 31, 2014, 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 2011. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH NORTHWEST ADMINISTRATORS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE ADMINISTRATION OFFICE REVIEWS THE FORM 990 AND WILL NOTIFY THE BOARD OF TRUSTEES IF ANY UNUSUAL OR SIGNIFICANT ITEMS ARE NOTED. THE TRUST CHAIRMAN AND SECRETARY REVIEW THE FORM 990 PRIOR TO PROVIDING SIGNATURES. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF TRUSTEES ARE COVERED BY THE CONFLICT-OF-INTEREST POLICY. IF AND WHEN A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE BOARD OF TRUSTEES WILL INVOLVE THE TRUST'S ATTORNEY TO EVALUATE IF THE MATTER WOULD LIKELY PREVENT AN UNBIASED OR OBJECTIVE DECISION BY A TRUSTEE. AS APPROPRIATE, DISCIPLINARY OR CORRECTIVE ACTION WILL BE TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MAINTAINED BY THE ADMINISTRATIVE OFFICE AND ARE AVAILABLE 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 INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, NORTHWEST ADMINISTRATORS, INC. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. GEORGIA PACIFIC LLC CA TEAMSTERS DISTRICT COUNCIL NO 2 710 E COMMONWEALTH AVENUE FULLERTON CA 92831 951296250 LABOR ORGANIZATION CA 501(C)5 N/A N/A 0 NEWSPAPER AGENCY CO LLC OMAHA POSTER & T-SHIRT LLC AAPCO WESTERN PRESS AMCOR PACKAGING DISTRIBUTION DBA CORRU-KRAFT AMCOR PACKAGING DISTRIBUTION DBA MISSION CORRUGATED AUTOMATIC PRINTING COMPANY INC GRAPHIC PACKAGING INT'L INC HOLLY PRESS INC INTERNATIONAL PAPER COMPANY KP CORPORATION LONGVIEW FIBRE PAPER AND PACKAGING INC PACKAGING CORPORATION OF AMERICA SUBURBAN PRESS INC SUN CHEMICAL CORP THARCO CONTAINERS INC WESTERN PRINTING INK CORP DAILY JOURNAL OF COMMERCE INC DAKOTA PRESS INC MOREL INC NATIONAL PRINTING COMPANY NEVADA DENTAL BENEFITS LIMITED 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 JANUARY 31, 2014, THERE ARE APPROXIMATELY 47 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 APPROXIMATELY 25 CONTRIBUTING EMPLOYERS IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS FOR WHICH THE ADMINISTRATIVE OFFICE HAS THE FEDERAL TAX CLASSIFICATION ARE LISTED ON PARTS II THROUGH IV, AND THE REMAINING CONTRIBUTING EMPLOYERS ARE LISTED BELOW IN PART VII. ALLIED PRINTING COMPANY CORRUGATED PACKAGING PRODUCTS, INC. CRS DATA SOLUTIONS GRAPHIC COMM UNION, INC GRAPHIC COMMUNICATIONS UNION RETIREMENT CENTER INC., DBA NORTHGATE TERRACE GREIF, INC. HOUSE OF PRINTING, INC. INDUSTRIAL BOXBOARD CORP LA PAPER BOX&BOARD(GARED GRAPHICS) MEAD-WESTVACO PACKAGING SYSTEMS MERCURY CONTAINER PACIFIC PAPER BOX CO. PACIFIC PRINTING (BU & NBU) RAPID DISPLAYS ROCKTENN - FKA: SMURFIT-STONE CONTAINERS ROTARY OFFSET PRESS ROYAL PAPER BOX SERVICE PRESS, INC SERVICE PRINTING SILICON VALLEY CONTAINER SL LITHOGRAPH LLC DBA HOLLYWOOD IMPRESS PRINTING STANDARD GRAPHIC ARTS CORP. (NBU) TEMPLE - INLAND INC. THE IRWIN HUDSON CO VINCENT A. CORBELLA, INC. DBA CHIMES PRINTING