2013-05-03T09:49:21-05:00 2012-06-30 952556670 BERNARD KOTKIN AND COMPANY LLP 533 SOUTH FREMONT AVENUE SUITE 802 LOS ANGELES CA 900711706 990 2011-07-01 956034886 OPERATING ENGINEERS HEALTH AND WELFARE FUND OPER 6263561000 100 EAST CORSON STREET PASADENA CA 91103 JOSEPH EHRBAR 6263561000 2013-05-02 P01406987 2138929090 2011 2016-02-25 16:41:14Z JOSEPH EHRBAR 100 EAST CORSON STREET PASADENA CA 91103 219246474 0 X WWW.OEFUNDS.ORG X 1954 CA TO PROVIDE MEDICAL BENEFITS TO APPROXIMATELY 10,000 ACTIVE AND 5,000 RETIRED PARTICIPANTS. 14 14 0 0 0 0 0 0 175425861 203237184 52133 12142 12891039 8382266 188369033 211631592 0 0 153193509 212610790 5904275 6266855 0 0 0 5259360 7359799 164357144 226237444 24011889 -14605852 56845991 62306749 105348272 125414882 -48502281 -63108133 THE FUND'S MISSION IS TO ADMINISTER AND PROVIDE MEDICAL, DENTAL, VISION, PRESCRIPTION DRUGS, DISABILITY AND DEATH BENEFITS TO THE ACTIVE AND RETIRED MEMBERS OF I.U.O.E LOCAL 12 AND THEIR DEPENDENTS AND BENEFICIARIES. 0 0 221707381 TO PROVIDE MEDICAL, HOSPITAL, DENTAL, LIFE INSURANCE, PRESCRIPTION DRUGS AND VISION BENEFITS TO APPROXIMATELY 10,000 ACTIVE AND 5,000 RETIRED PARTICIPANTS. 221707381 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 390 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 1 0 0 CA X OPERATING ENGINEERS FUNDS INC 6263561000 100 EAST CORSON STREET PASADENA CA 91103 DAN BILLY 1.00 X 0 118174 39223 LARRY DAVISON 1.00 X 0 0 0 MICHAEL CRAWFORD 1.00 X 0 0 0 CHARLES W POSS 1.00 X 0 0 0 DAN HAWN 1.00 X 0 118018 39223 WILLIAM WAGGONER 1.00 X 0 254381 39223 STEVE BILLY 1.00 X 0 180653 39223 MICKEY J ADAMS 1.00 X 0 178250 39223 WALT ELLIOT 1.00 X 0 0 0 KURT GLASS 1.00 X 0 180607 39223 MITCH WHITE 1.00 X 0 0 0 JOHN NELSON 1.00 X 0 0 0 FRED YOUNG 1.00 X 0 184615 39223 MIKE RODDY 1.00 X 0 0 0 RON SIKORSKI 1.00 X 0 169381 39223 BRUCE COOKSEY 1.00 X 0 0 0 RODNEY GOODWIN 35.00 X 0 0 27383 MICHAEL GRAYDON 35.00 X 0 253642 30051 MARGARET BOWEN 35.00 X 0 226345 30051 MICHAEL DECHELLIS 35.00 X 0 149546 30051 0 2013612 431320 0 0 1 0 CAREMARK LLC 2211 SANDERS ROAD NORTHBROOK IL 60062 PRESCRIPTION DRUG PROVIDER 42326683 KAISER FOUNDATION HEALTH PLAN PO BOX 80204 LOS ANGELES CA 90080 HEALTH CARE PROVIDER 20985760 HEALTH NET FILE 52617 LOS ANGELES CA 90074 HEALTH CARE PROVIDER 14673219 VISION SERVICE PLAN PO BOX 45210 SAN FRANCISCO CA 94145 VISION CARE PROVIDER 1462018 HEALTH PLAN OF NEVADA PO BOX 749546 LOS ANGELES CA 90074 HEALTH CARE PROVIDER 1339740 5 EMPLOYER CONTRIBUTIONS 900099 175466757 175466757 SELF PAY PREMIUMS 900099 27278072 27278072 DELINQUENCY ASSESSMENT 900099 352116 352116 MISCELLANEOUS 900099 132722 132722 INTEREST ON DELINQUENC 900099 7517 7517 203237184 12120 12120 7614904 7614882 22 22 22 REBATES & SUBSIDIES 900099 8382266 8382266 8382266 211631592 211631570 0 22 212610790 212610790 4617488 3258043 1359445 490815 373355 117460 781400 594398 187002 377152 286893 90259 898068 898068 90028 41673 48355 61265 61265 913054 747876 165178 787112 471714 315398 502180 36973 465207 794290 283675 510615 20454 20454 11073 11073 56828 56828 28162 28162 103775 103775 143277 23596 119681 CLAIMS REVIEW EXPENSE 1477765 1477765 BLUE CROSS DUES & EXP. 1459504 1459504 CASE MANAGEMENT 12964 12964 226237444 221707381 4530063 0 28333907 36096654 28397084 26095095 115000 115000 56845991 62306749 4815272 5430882 5000000 100533000 114984000 105348272 125414882 X 0 0 0 0 -48502281 -63108133 -48502281 -63108133 56845991 62306749 -14605852 0 X X 0 1 1 X 0 0 MEDICAL BENEFITS PAYABLE 109984000 NOTE PAYABLE TO LOCAL 12 5000000 114984000 211631592 226237444 -14605852 -14605852 211631592 0 211631592 0 211631592 216786444 0 216786444 9451000 9451000 226237444 PART XIII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN PLAN'S TOTAL BENEFIT OBLIGATIONS, OTHER THAN POSTRETIREMENT 9,451,000. X 1 1 X X X 0 0 0 DAN BILLY 0 118174 0 0 0 0 0 0 0 39223 0 157397 0 0 DAN HAWN 0 118018 0 0 0 0 0 0 0 39223 0 157241 0 0 WILLIAM WAGGONER 0 254381 0 0 0 0 0 0 0 39223 0 293604 0 0 STEVE BILLY 0 180653 0 0 0 0 0 0 0 39223 0 219876 0 0 MICKEY J ADAMS 0 178250 0 0 0 0 0 0 0 39223 0 217473 0 0 KURT GLASS 0 180607 0 0 0 0 0 0 0 39223 0 219830 0 0 FRED YOUNG 0 184615 0 0 0 0 0 0 0 39223 0 223838 0 0 RON SIKORSKI 0 169381 0 0 0 0 0 0 0 39223 0 208604 0 0 MICHAEL GRAYDON 0 253642 0 0 0 0 0 13923 0 16128 0 283693 0 0 MARGARET BOWEN 0 226345 0 0 0 0 0 13923 0 16128 0 256396 0 0 MICHAEL DECHELLIS 0 149546 0 0 0 0 0 13923 0 16128 0 179597 0 0 PART I, LINE 1A PER THE TRAVEL & EXPENSE REIMBURSEMENT POLICY, IF TRAVEL TIME EXCEEDS TWO HOURS AND IS NOT ON THE WEST COAST, FIRST-CLASS TRAVEL IS AN OPTION. OTHERWISE, AIR TRAVEL IS LIMITED TO COACH. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION'S MANAGEMENT DUTIES ARE DELEGATED TO THE OPERATING ENGINEERS FUNDS, INC. THEIR RESPONSIBILITY IS TO MAINTAIN ACCOUNTING RECORDS, INTERNAL FIANCIAL STATEMENTS AND PARTICIPANT RECORDS. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD OF TRUSTEES AND FUND MANAGER REVIEWS THE FORM 990 BEFORE FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 15A IN 2008, THE FUND MANAGER NEGOTIATED AN EMPLOYMENT CONTRACT WITH THE BOARD OF TRUSTEES. COMPENSATION FOR THE OTHER KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES IS BASED ON COMPARABLE COMPENSATION AT SIMILAR ORGANIZATIONS. COMPENSATION FOR THESE INDIVIDUALS WAS ADJUSTED BY THE FUND MANAGER IN FISCAL YEAR 2010. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION UPON REQUEST AT THEIR ADMINISTRATIVE OFFICE, WHICH IS LOCATED AT 100 EAST CORSON STREET, 1ST FLOOR, IN PASADENA, CA. FORM 990, PART XII, LINE 2C: THE ORGANIZATION DOES NOT HAVE A SEPARATE AUDIT COMMITTEE. THE BOARD OF TRUSTEES HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF INDEPENDENT ACCOUNTANTS. OPERATING ENGINEERS PENSION TRUST 100 EAST CORSON STREET PASADENA CA 91103 956032478 TO PROVIDE PENSION BENEFITS TO RETIRED ELIGIBLE MEMBERS. CA 401(A) 0 OPERATING ENGINEERS JOURNEYMAN & APPRENTICESHIP TRAINING TRUST 100 EAST CORSON STREET PASADENA CA 91103 956105499 TO TRAIN ELIGIBLE OPERATING ENGINEER JOURNEYMEN. CA 501(C)(5) 0 OPERATING ENGINEERS VACATION-HOLIDAY SAVINGS TRUST 100 EAST CORSON STREET PASADENA CA 91103 956067144 TO PROVIDE SAVINGS BENEFITS TO ELIGIBLE MEMBERS. CA 501(C)(9) 0 OPERATING ENGINEERS FUNDS INC 100 EAST CORSON STREET PASADENA CA 91103 952694167 TO ADMINISTER THE TRUST FUNDS FOR I.U.O.E. LOCAL 12 CA C 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 IDENTIFICATION OF CONTRIBUTING EMPLOYERS AS RELATED ORGANIZATIONS: FORM 990, SCHEDULE R, PARTS III AND OR IV THE FUND A HAS APPROXIMATELY 1100 CONTRIBUTING EMPLOYERS. A REASONABLE EFFORT WAS MADE TO OBTAIN THE INFORMATION, BUT THE PLAN IS UNABLE TO PROVIDE THE INFORMATION FOR ALL CONTRIBUTING EMPLOYERS. FOR ADDITIONAL INFORMATION PLEASE CONTACT THE PLAN OFFICE.