2012-04-04T11:42:44-05:00 2011-08-31 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2010-09-01 946667029 CALIFORNIA TEACHERS ASSOC EMPLOYEES' HEALTH AND WELFARE BENEFITS TRUST CALI 5032825581 PO BOX 4148 PORTLAND OR 97208 ROSEANNE BECHER 5032825581 2012-04-04 1 9252779100 2010 2016-02-24 21:20:13Z ROSEANNE BECHER PO BOX 4148 PORTLAND OR 97208 27642562 0 X N/A X 1993 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 9 9 0 0 0 0 0 0 19429155 19175634 1242477 835626 4391 0 20676023 20011260 0 0 19464087 20314903 0 0 0 0 0 1794223 1626633 21258310 21941536 -582287 -1930276 19727540 17889400 1642621 1454669 18084919 16434731 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 1 0 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 0 1 5 0 1 0 0 0 0 0 0 0 X 9 9 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 ROSEANNE N BECHER 3.00 X 0 0 0 DAVID SANCHEZ 2.00 X 0 0 0 MERRI BOSTON 2.00 X 0 0 0 CAROLYN DOGGETT 2.00 X 0 0 0 JOHN STEPHENS JR 2.00 X 0 0 0 LIZ TOKAR 2.00 X 0 0 0 GERRY FONG 2.00 X 0 0 0 LISA ADAMS 2.00 X 0 0 0 ERIC HEINS 3.00 X 0 0 0 MIKKI CICHOCKI 2.00 X 0 0 0 JIM SCHLOTZ 2.00 X 0 0 0 ROSE LUNA NUNEZ 2.00 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS OF CALIFORNIA 801 S FIGUEROA STREET 5TH FLOOR LOS ANGELES CA 90017 CLAIMS ADMINISTRATION 694298 THE WILLIAM C EARHART COMPANY PO BOX 4148 PORTLAND OR 97208 CONTRACT ADMINISTRATION 208028 HORIZON CONSULTING 6120 ROLLING ROAD DR MIAMI FL 33156 CONSULTING 168541 3 EMPLOYER CONTRIBUTIONS 900099 18512642 18512642 RETIREE MEDICARE SUBSI 900099 315014 315014 EARLY RETIREE REINSURA 900099 240673 240673 PARTICIPANT CONTRIBUTI 900099 107305 107305 19175634 736928 736928 7730000 7631302 98698 98698 98698 20011260 19175634 0 835626 20314903 177000 60079 53693 25000 1157446 44763 15984 38120 45923 OTHER EXPENSES 8625 21941536 -201959 -302044 1063058 1442945 1360873 1244521 62314 54353 15449625 17443254 19727540 17889400 156421 155869 1486200 1298800 1642621 1454669 X 0 0 0 0 18084919 16434731 18084919 16434731 19727540 17889400 X -1930276 280088 X X 0 1 1 X 0 0 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 1298800 1298800 20011260 21941536 -1930276 280088 280088 -1650188 20266348 280088 280088 19986260 25000 25000 20011260 22103936 0 22103936 25000 -187400 -162400 21941536 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS PART XIII, 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 280088. 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 TO PROVIDE RETIREMENT BENEFITS CA 501(A) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0