2013-07-15T11:04:38-05:00 2012-12-31 840676265 SSA PC 3355 American Drive Colorado Springs CO 809175707 990 2012-01-01 870496328 IBEWWestern Utilities Health and Welfare Trust Fund UTAH 9252089999 7180 Koll Center Parkway 200 Pleasanton CA 94566 Julie Lewis 5038135048 2013-07-12 1 William C Sanden CPA P00013248 7195740100 2012 2016-02-24 21:20:13Z Julie Lewis 825 E Multnomah Portland OR 97232 39013289 0 X n/a X 1991 UT Provide medical, dental and life insurance benefits 8 8 0 0 0 0 0 0 34204921 35270745 327760 352349 3083 131 34535764 35623225 0 0 31093449 32842288 0 0 0 0 0 1734813 1672067 32828262 34514355 1707502 1108870 12963403 15392127 6319618 7508408 6643785 7883719 To provide medical, dental and life insurance benefits to participants of the Plan. 0 0 33441034 The Plan provides medical, dental and life insurance benefits under a collectively bargained agreement between IBEW Local Union 57 and PacifiCorp dba Rocky Mountain Power. 33441034 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 1357 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1 0 0 0 X Benesys 9252089999 7180 Koll Center Parkway 200 Pleasanton CA 94566 X Brent Donohue 2.00 X 0 0 0 Calvin Ockey 2.00 X 0 0 0 Gary Cox 2.00 X 0 0 0 Julie Lewis 2.00 X 0 0 0 Erich Wilson 2.00 X 0 0 0 Travis Eri 2.00 X 0 0 0 Paul Radakovich 2.00 X 0 0 0 Jeremy Courval 2.00 X 0 0 0 0 0 0 0 0 0 0 0 Contributions Medical 524114 33853998 33853998 Contributions Life 524113 1316155 1316155 Self Pay Cobra Medical 524114 90689 90689 Flex Forfeitures 524114 9903 9903 35270745 273823 273823 3468590 3390064 78526 78526 78526 Other 900099 131 131 131 35623225 35349402 0 273823 32842288 32842288 30730 30730 29065 29065 3518 3518 9262 9262 Administrative Fees - C 548983 548983 Consultant Fee - Segal 254587 254587 PPO Fees - Cigna 185600 185600 PPO Fee - Wise 113357 113357 496965 299789 197176 34514355 33441034 1073321 0 1090637 1986165 908721 1600378 604631 435897 17783 26874 10341631 11342813 12963403 15392127 185143 473282 6134475 7035126 6319618 7508408 X 6643785 7883719 6643785 7883719 12963403 15392127 1108870 131064 0 X 0 1 X 1 0 0 Claims Incurred Not Reported 6365000 Claims Payable 670126 7035126 X 35660480 131064 131064 35529416 93809 93809 35623225 33519896 0 33519896 93809 900650 994459 34514355 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Plan has adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740, Accounting for Uncertainty in Income Taxes, which prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return and also provides guidance on various related matters such as derecognition, interest, penalties and disclosures required. The Plans determination as a tax-exempt entity is considered a tax position subject to the requirements of ASC 740. There were no unrecognized tax benefits at December 31, 2012, and the Plan does not believe it is reasonably possible that unrecognized tax benefits related to this tax position will significantly change within twelve months of the reporting date. The Plan would recognize interest and penalties, if any, related to unrecognized tax benefits as income tax expense. The Plan did not have any accrued liabilities or expense for interest or penalties related to unrecognized tax benefits for the years ended December 31, 2011 and 2010. Part XII, Line 4b - Other Adjustments: Claims Incurred Not Reported $1649000 Claims Payable and Flex Spending Adjustment $-748350 Form 990, Part VI, Section B, line 11 The Form 990 is reviewed at the Board of Trustees meeting prior to filing the return. All board members have the opportunity to ask questions. The board chairman signs the return at the conclusion of the discussion and is responsible for mailing the return. Form 990, Part VI, Section C, line 19 The documents and financial statements are available upon request by any interested party. PacificorpIBEW Local 57 Retirement Trust Fund 825 NE Multnomah Portland OR 97232 870640888 Provide retirement benefits to participants OR 501(c)9 0 PacifiCorp 825 NE Multnomah Portland OR 97232 870023145 Utility/construction OR N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0