2014-05-15T17:55:13-05:00 2013-08-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2012-09-01 946667029 CALIFORNIA TEACHERS ASSOC EMPLOYEES' HEALTH AND WELFARE BENEFITS TRUST CALI 5032825581 PO BOX 4148 PORTLAND OR 97208 ERIC HEINS 5032825581 2014-05-16 1 KATHLEEN D HAAB P01068129 9252779100 2012 2015-11-30 17:44:51Z ERIC HEINS PO BOX 4148 PORTLAND OR 97208 25341186 0 X N/A X 1993 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 9 0 0 0 0 0 0 0 20496743 19869396 -338984 917990 612 0 20158371 20787386 0 0 19398691 20577666 0 0 0 0 0 1613437 1770286 21012128 22347952 -853757 -1560566 18231889 16765620 1511786 1608366 16720103 15157254 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 7 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 X DEAN VOGEL 2.00 X 0 0 0 JOE NUNEZ 2.00 X 0 0 0 KATIE MULLINS 2.00 X 0 0 0 JAKE ANDERSON 2.00 X 0 0 0 AMIHAN MAKAYAN 2.00 X 0 0 0 JOHN STEPHENS JR 3.00 X 0 0 0 CHUCK KING 2.00 X 0 0 0 CAROLYN DOGGETT 2.00 X 0 0 0 WANDA TURNER 2.00 X 0 0 0 ERIC HEINS 3.00 X 0 0 0 RANNY KRAVETZ 2.00 X 0 0 0 ROSE LUNA NUNEZ 2.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM BLUE CROSS OF CALIFORNIA 801 S FIGUEROA STREET 5TH FLOOR LOS ANGELES CA 90017 CLAIMS ADMINISTRATION 768593 THE WILLIAM C EARHART COMPANY PO BOX 4148 PORTLAND OR 97208 CONTRACT ADMINISTRATION 200368 HORIZON CONSULTING 6120 ROLLING ROAD DR MIAMI FL 33156 CONSULTING 196253 3 EMPLOYER CONTRIBUTIONS 900099 19452592 19452592 RETIREE MEDICARE SUBSI 900099 315685 315685 PARTICIPANT CONTRIBUTI 900099 101119 101119 19869396 507790 507790 4964000 4553800 410200 410200 410200 20787386 19869396 0 917990 20577666 190800 60603 95987 25000 1228737 49445 23088 36689 47452 OTHER EXPENSES 12485 22347952 812839 936389 8470 8471 1602148 1278517 58710 76817 15749722 14465426 18231889 16765620 178386 199266 1333400 1409100 1511786 1608366 X 0 0 0 0 16720103 15157254 16720103 15157254 18231889 16765620 -1560566 -2283 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 1409100 1409100 X 20760103 -2283 -2283 20762386 25000 25000 20787386 22247252 0 22247252 25000 75700 100700 22347952 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013, 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 2010. 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 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, 2013, THERE ARE APPROXIMATELY 52 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. CTA-STAFF CALIFORNIA FACULTY ASSN ALHAMBRA TEACHERS ASSN ANAHEIM EDUCATORS ALAMEDA EDUCATION ASSN RIVERSIDE CITY TEACHERS ASSOCIATED POMONA TEACHER BLOSSOM RIDGE UNISERV CALIFORNIA RETIRED TCHRS CITRUS BELT UNISERV CITRUS BELT-RIALTO COMPTON EDUCATION ASSN CORONA NORCO TCHRS ASSN FONTANA TEACHERS ASSN FREMONT UNIFIED TEACHERS FRESNO TEACHERS ASSN GARDEN GROVE EDUCATION AS LOS ANGELES - CEA LYNWOOD TEACHERS ASSOCIAT MERCED-MARIPOSA TCHRS UNI MONTEBELLO TEACHERS ASSN MT HAMILTON CTA/NEA NORTH ORANGE CTY UTD TCHR OAKLAND EDUCATION ASSN ONTARIO-MONTCLAIR TEACHER ORANGE UNIFIED EDUCATION PUENTE HILLS UNISERV RANCHO CERRITOS UNITED TC SACRAMENTO CITY TCHRS ASN SAN BERNARDINO TCHRS ASSN SAN DIEGO COASTAL UNITED SAN DIEGO EDUCATION ASSN SAN JUAN TEACHERS ASSN SAN MATEO TEACHERS ASSN SANTA ANA EDUCATORS ASSN SOUTH BAY UNITED TEACHERS SOUTH COUNTY TCHRS UNITED STOCKTON TEACHERS ASSN TEACHERS ASSN OF LONG BEA TEACHERS UNITED UNISERV TORRANCE TEACHERS ASSN TRI-CITY EDUCATORS ASSN UTD EDUCATORS OF SAN FRAN UNITED TEACHERS OF RICHMO VENTURA UNIFIED WEST ORANGE CTY UNITED TC WHITTIER SECONDARY EDUC A REDLANDS TEACHERS ASSN TWIN LAKES UNISERV ASSOCIATED CHINO TEACHERS CAPISTRANO UNIF EDUC ASSN NATIONAL EDUC ASSN JURUPA