FURP.ORG / PUBLIC DATA EXPLORER

OREGON TEAMSTER EMPLOYERS TRUST: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
OREGON TEAMSTER EMPLOYERS TRUST (EIN 93-6021475)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-15
IRS object ID
201212919349300341
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-10-15T17:31:10-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN522385296EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LINDQUIST LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15000 EXECUTIVE PARKWAY SUITE 400AddressLine1
CitySAN RAMONCity
StateCAState
ZIP Code94583ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN936021475EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1OREGON TEAMSTER EMPLOYERS TRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlOREGNameControl
Phone5032825581Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 4148AddressLine1
CityPORTLANDCity
StateORState
ZIP Code972084148ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSTEPHEN S ERDMANNName
TitleTRUSTEETitle
Phone5032825581Phone
Date Signed2012-10-17DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKATHLEEN D HAABName
PTINP01068129PTIN
Phone9252779100Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSTEPHEN S ERDMANNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 4148AddressLine1
CityPORTLANDCity
StateORState
ZIP Code972084148ZIPCode
FieldValueIRS element (for citing)
Gross Receipts229046205GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1957YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH BENEFITS TO PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members2NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year152733286ProgramServiceRevenuePriorYear
Program Service Revenue CY157327779ProgramServiceRevenueCY
Investment Income Prior Year1173947InvestmentIncomePriorYear
Investment Income Current Year1205223InvestmentIncomeCurrentYear
Other Revenue Prior Year24061OtherRevenuePriorYear
Other Revenue Current Year83996OtherRevenueCurrentYear
Total Revenue Prior Year153931294TotalRevenuePriorYear
Total Revenue Current Year158616998TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year142265468BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY139015467BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8142183OtherExpensePriorYear
Other Expenses Current Year7871019OtherExpensesCurrentYear
Total Expenses Prior Year150407651TotalExpensesPriorYear
Total Expenses Current Year146886486TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3523643RevenuesLessExpensesPriorYear
Revenues Less Expenses CY11730512RevenuesLessExpensesCY
Total Assets BOY53537615TotalAssetsBOY
Total Assets EOY62838561TotalAssetsEOY
Total Liabilities BOY26859169TotalLiabilitiesBOY
Total Liabilities EOY24635661TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY26678446NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY38202900NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDE HEALTH, DENTAL, VISION, LIFE INSURANCE AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionPROVIDED HEALTH, DENTAL, VISION, LIFE INSURANCE AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10969NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members2NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1THE WILLIAM C EARHART CO INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5032825581TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13140 NE BROADWAY STREETAddressLine1
CityPORTLANDCity
StateORState
ZIP Code97232ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DAN RATTY
TRUSTEE1.00X000
STEVE PICKLE
TRUSTEE1.00X000
GREG BAXTER
TRUSTEE1.00X000
JOHN SILVA
TRUSTEE1.00X000
TOM WATT
TRUSTEE1.00X000
STEPHEN ERDMANN
TRUSTEE1.00X000
CARL WOJCIECHOWSKI
TRUSTEE1.00X000
JENNIFER MONTGOMERY
TRUSTEE1.00X000
ADAM WINSTON
TRUSTEE1.00X000
JERRY D'AMBROSIO
TRUSTEE1.00X000
BOB SLEIGHT
TRUSTEE1.00X000
KENNETH JOHNSON
TRUSTEE1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
REGENCE BLUE CROSS BLUE SHIELD
100 SW MARKET STREETPORTLANDOR972015702CLAIMS ADMINISTRATION6123532
WILLIAM C EARHART CO INC
3140 NE BROADWAY STPORTLANDOR97232THIRD PARTY ADMINISTRATIVE FEES785828
SCRIBNER SCRIBNER & SUTTON
1523 NE 6TH AVENUEPORTLANDOR97232PAYROLL AUDITS183964
MILLIMAN INC
650 CALIFORNIA STREET 17TH FLOORSAN FRANCISCOCA94108CONSULTING SERVICES112400
VISION SERVICE PLAN
3333 QUALITY DRIVERANCHO CORDOVACA95670CLAIMS ADMINISTRATION108827
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS900099146161517146161517
PARTICIPANT CONTRIBUTI90009973798877379887
PRESCRIPTION REBATES90009921597872159787
MEDICARE PART D SUBSID900099557711557711
HRA CONTRIBUTIONS900099454997454997

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column613880TotalRevenueColumn
Related Or Exempt Function Income613880RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue157327779TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1034423TotalRevenueColumn
Exclusion$1,034,423ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities70600007Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities70429207Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities170800Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column170800TotalRevenueColumn
Exclusion$170,800ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CLASS ACTION SETTLEMEN9000997543675436
OTHER INCOME90009985608560
FieldValueIRS element (for citing)
Total Other Revenue83996TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column158616998TotalRevenueColumn
Related Or Exempt Function Income157411775RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,205,223ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total139015467Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total768726Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total148240Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total224682Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total94409Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6360405Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total149999Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total29868Total

Insurance Insurance

FieldValueIRS element (for citing)
Total94690Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total146886486Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6685388BOY
EOY4383212EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY15359837BOY
EOY13410347EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY31492390BOY
EOY45045002EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY53537615BOY
EOY62838561EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY699840BOY
EOY624801EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY567997BOY
EOY531535EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY25591332BOY
EOY23479325EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY26859169BOY
EOY24635661EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY26678446BOY
EOY38202900EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY26678446BOY
EOY38202900EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY53537615BOY
EOY62838561EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses11730512ReconcilationRevenueExpenses
Reconcilation Other Changes-206058ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
CLAIMS PAYABLE AND IBNR$10,850,000
PREMIUMS PAYABLE$1,062,325
ACCUMULATED ELIGIBILITY CREDITS$11,567,000
FieldValueIRS element (for citing)
Total Of Amounts23479325TotalOfAmounts
Total Revenue158616998TotalRevenue
Total Expenses146886486TotalExpenses
Excess Or Deficit For Year11730512ExcessOrDeficitForYear
Net Unrealized GL On Investments-206058NetUnrealizedGLOnInvestments
Other-$2,112,007OtherAmount
Total Adjustments-2318065TotalAdjustments
Excess Or Deficit Per FS9412447ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt158316531TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-206058NetUnrealizedGainsInvestments
Revenue Not Rptd F990-206058RevenueNotRptdF990
Revenue Subtotal158522589RevenueSubtotal
Investment Expenses Not Included94409InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt94409RevenueNotRptdOnFinStmt
Total Revenue Per Form990158616998TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt148904084TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal148904084ExpensesSubtotal
Investment Expenses Not Included294409InvestmentExpensesNotIncluded2
Other Expenses Not Included-2112007OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt-2017598ExpensesNotRptdOnFinStmt
Total Expenses Per Form990146886486TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011, 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 YEARS PRIOR TO 2008.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN BENEFIT OBLIGATIONS
PART XIII, LINE 4B - OTHER ADJUSTMENTS:CHANGE IN BENEFIT OBLIGATIONS

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3THE PLAN HAS CONTRACTED WITH WILLIAM C. EARHART CO., INC TO PROVIDE DAY TO DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PROVIDED TO THE GOVERNING BODY FOR THEIR REVIEW AND COMMENTS PRIOR TO FILING THE RETURN WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CANY TRUSTEE OR SERVICE PROVIDER AUTHORIZED TO CONDUCT TRANSACTIONS ON BEHALF OF THE TRUST WHO HAS REASON TO BELIEVE THAT A PROPOSED TRANSACTION MIGHT CONSTITUTE A PROHIBITED TRANSACTION WITH A PARTY-IN-INTEREST SHOULD CONSULT WITH TRUST COUNSEL AND TAKE WHATEVER ADDITIONAL ACTION MAY BE APPROPRIATE TO ENSURE THAT THE PROPOSED TRANSACTION IS APPROPRIATE. ANY FIDUCIARY WHOSE PARTICIPATION IN A DECISION MAY RESULT IN A NON-EXEMPTED PROHIBITED TRANSACTION UNDER SECTION 406 OF ERISA SHALL RECUSE HIMSELF OR HERSELF FROM DISCUSSION OR VOTING ON SUCH DECISION. THE TRUST OFFICE SHALL ANNUALLY DISTRIBUTE A PARTY-IN-INTEREST QUESTIONNAIRE TO PLAN FIDUCIARIES IN CONJUNCTION WITH THE ANNUAL AUDIT.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -206,058.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSIGHT OF THE ANNUAL AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1SEE EXPLANATION AT PART VIIBusinessNameLine1
FieldValueIRS element (for citing)
Primary ActivityVARIOUSPrimaryActivity
Legal Domicile StateORLegalDomicileState
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
ExplanationSCHEDULE 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 DECEMBER 31, 2011, THERE ARE APPROXIMATELY 200 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.Explanation