2012-10-15T17:31:10-05:00 2011-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2011-01-01 936021475 OREGON TEAMSTER EMPLOYERS TRUST OREG 5032825581 PO BOX 4148 PORTLAND OR 972084148 STEPHEN S ERDMANN 5032825581 2012-10-17 1 KATHLEEN D HAAB P01068129 9252779100 2011 2016-02-24 21:20:13Z STEPHEN S ERDMANN PO BOX 4148 PORTLAND OR 972084148 229046205 0 X N/A X 1957 OR TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 12 2 0 0 0 0 0 0 152733286 157327779 1173947 1205223 24061 83996 153931294 158616998 0 0 142265468 139015467 0 0 0 0 0 8142183 7871019 150407651 146886486 3523643 11730512 53537615 62838561 26859169 24635661 26678446 38202900 PROVIDE HEALTH, DENTAL, VISION, LIFE INSURANCE AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 PROVIDED HEALTH, DENTAL, VISION, LIFE INSURANCE AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS. 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 0 1 9 0 1 0 0 0 0 0 0 0 X 12 2 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE WILLIAM C EARHART CO INC 5032825581 3140 NE BROADWAY STREET PORTLAND OR 97232 X DAN RATTY 1.00 X 0 0 0 STEVE PICKLE 1.00 X 0 0 0 GREG BAXTER 1.00 X 0 0 0 JOHN SILVA 1.00 X 0 0 0 TOM WATT 1.00 X 0 0 0 STEPHEN ERDMANN 1.00 X 0 0 0 CARL WOJCIECHOWSKI 1.00 X 0 0 0 JENNIFER MONTGOMERY 1.00 X 0 0 0 ADAM WINSTON 1.00 X 0 0 0 JERRY D'AMBROSIO 1.00 X 0 0 0 BOB SLEIGHT 1.00 X 0 0 0 KENNETH JOHNSON 1.00 X 0 0 0 0 0 0 0 0 0 0 REGENCE BLUE CROSS BLUE SHIELD 100 SW MARKET STREET PORTLAND OR 972015702 CLAIMS ADMINISTRATION 6123532 WILLIAM C EARHART CO INC 3140 NE BROADWAY ST PORTLAND OR 97232 THIRD PARTY ADMINISTRATIVE FEES 785828 SCRIBNER SCRIBNER & SUTTON 1523 NE 6TH AVENUE PORTLAND OR 97232 PAYROLL AUDITS 183964 MILLIMAN INC 650 CALIFORNIA STREET 17TH FLOOR SAN FRANCISCO CA 94108 CONSULTING SERVICES 112400 VISION SERVICE PLAN 3333 QUALITY DRIVE RANCHO CORDOVA CA 95670 CLAIMS ADMINISTRATION 108827 5 EMPLOYER CONTRIBUTIONS 900099 146161517 146161517 PARTICIPANT CONTRIBUTI 900099 7379887 7379887 PRESCRIPTION REBATES 900099 2159787 2159787 MEDICARE PART D SUBSID 900099 557711 557711 HRA CONTRIBUTIONS 900099 454997 454997 613880 613880 157327779 1034423 1034423 70600007 70429207 170800 170800 170800 CLASS ACTION SETTLEMEN 900099 75436 75436 OTHER INCOME 900099 8560 8560 83996 158616998 157411775 0 1205223 139015467 768726 148240 224682 94409 6360405 149999 29868 94690 146886486 6685388 4383212 15359837 13410347 31492390 45045002 53537615 62838561 699840 624801 567997 531535 25591332 23479325 26859169 24635661 X 0 0 0 0 26678446 38202900 26678446 38202900 53537615 62838561 X 11730512 -206058 X X 0 1 1 X 0 0 CLAIMS PAYABLE AND IBNR 10850000 PREMIUMS PAYABLE 1062325 ACCUMULATED ELIGIBILITY CREDITS 11567000 23479325 158616998 146886486 11730512 -206058 -2112007 -2318065 9412447 158316531 -206058 -206058 158522589 94409 94409 158616998 148904084 0 148904084 94409 -2112007 -2017598 146886486 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 FORM 990, PART VI, SECTION A, LINE 3 THE 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 11 THE 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 12C ANY 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -206,058. 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. SEE EXPLANATION AT PART VII VARIOUS OR 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 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.