2022-05-26T19:46:40-05:00 2021-07-31 931015766 BJORKLUND & MONTPLAISIR CPA'S 10300 SW GREENBURG ROAD STE 470 PORTLAND OR 97223 990 2020-08-01 936027865 TEAMSTERS 206 EMPLOYERS TRUST BOARD OF TRUSTEES TEAM 5032386961 700 NE MULTNOMAH STREET SUITE 350 PORTLAND OR 972324197 GENE BLACKBURN TRUSTEE 5032386961 2022-05-11 true GENE BLACKBURN 999009999 RICHARD A LAYNE P00359754 5036436400 2022-05-26 2020 2022-09-23 18:48:47Z GENE BLACKBURN 1860 NE 162ND AVE PORTLAND OR 97230 36385767 false X X 1958 OR PROVIDE HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. 3 3 0 0 0 34041734 30961689 1026114 1925500 5303 114880 35073151 33002069 0 29629038 27614400 0 0 0 1342007 1243300 30971045 28857700 4102106 4144369 45723043 49828794 4342812 4458473 41380231 45370321 PROVIDE HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. false false PROVIDE HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. false false false false false false false false false false false false false true false true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 518 0 0 false false false false false false false false X 3 3 false false false false false false false true true false false true true true true true true true true false X X NORTHWEST ADMINISTRATORS INC 5034166901 700 NE MULTNOMAH PORTLAND OR 97232 X GENE BLACKBURN TRUSTEE 1.00 X 0 0 0 THOMAS LEEDHAM TRUSTEE/CHAI 1.00 X X 0 0 0 DONA PIERCY TRUSTEE 1.00 X 0 0 0 false false false NORTHWEST ADMINISTRATORS INC 700 NE MULTNOMAH ST SUITE 350 PORTLAND OR 972324197 ADMINISTRATION 422399 CIGNA 701 5TH AVE SEATTLE WA 98104 MEDICAL MANAGMT 419358 MODA HEALTH 601 SW SECOND PORTLAND OR 97204 CLAIMS ADMINITR 133735 WILLIAM LACOUR LLC 6146 CHURCHILL DOWNS DRIVE WEST LINN OR 97068 CONSULTANT 111026 4 EMPLOYER CONTRIBUTIONS 28348133 28348133 PARTICIPANT CONTRIBUTIONS 2613556 2613556 30961689 622682 622682 4686516 3383698 1302818 1302818 1302818 LIQUIDATED DAMAGES/INTEREST 114880 114880 114880 33002069 33002069 27614400 54403 29656 70925 1051501 22315 1065 13435 28857700 0 0 0 10721 1049 6031263 4701471 2334217 2914118 8243 10297 36836499 41607241 502100 594618 45723043 49828794 123287 122306 4219525 4336167 4342812 4458473 X 41380231 45370321 41380231 45370321 45723043 49828794 4144369 -154279 X false true X true false INSURANCE PREMIUMS PAYABLE 1725075 CLAIMS INCURRED BUT NOT PAID 1500000 CLAIMS PAYABLE FOR MEDICAL BENEFITS 1111092 4336167 32776865 -154279 -154279 32931144 70925 70925 33002069 28670133 -116642 -116642 28786775 70925 70925 28857700 SCHEDULE D, PAGE 4, PART XII, LINE 2D CHANGE IN BENEFIT OBLIGATIONS -116,642 FORM 990, PAGE 6, PART VI, LINE 11B FORM 990 IS REVIEWED BY THE PLAN'S LEGAL COUNSEL AND THIRD PARTY ADMINISTRATOR, AND PRESENTED TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE FILING. FORM 990, PAGE 6, PART VI, LINE 12C THE TRUSTEES AND SERVICE PROVIDERS ARE EXPECTED TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICT OF INTEREST UPON DISCOVERY. IT WILL THEN BE REVIEWED BY THE PLAN'S LEGAL COUNSEL. FORM 990, PAGE 6, PART VI, LINE 15A NO COMPENSATION IS PAID. FORM 990, PAGE 6, PART VI, LINE 15B NO COMPENSATION IS PAID. FORM 990, PAGE 6, PART VI, LINE 19 MADE AVAILABLE UPON REQUEST THROUGH THE PLAN'S THIRD PARTY ADMINISTRATOR. ALSO AVAILABLE AT WWW.GUIDESTAR.ORG CITY OF BANDON N/A false CITY OF COQUILLE N/A false CITY OF REEDSPORT N/A false CITY OF TURNER N/A false CURRY COUNTY N/A false PORTLAND PUBLIC SCHOOLS N/A false WAREHOUSEMEN'S LOCAL N/A false AMALGAMATED SUGAR CO N/A false false ALASKAN COPPER & BRASS N/A false AMERICAN STEEL CORPORATION N/A false ARAMARK UNIFORM & CAREER APPAREL N/A false BAY AREA HOSPITAL N/A false CALBAG METALS CO N/A false DISTRIBUTION INTERNATIONAL N/A false EARLE M JORGENSEN CO N/A false FOOD SERVICES OF AMERICA N/A false KROGER N/A false LEHIGH NORTHWEST CEMENT CO N/A false LOWER UMPQUA HOSPITAL N/A false MCDONALD WHOLESALE CO N/A false MONDELEZ - PORTLAND N/A false REYES HOLDINGS N/A false SMART & FINAL N/A false SYSCO FOOD SERVICES INC N/A false UNIVAR SOLUTIONS USA N/A false VALLEY CREST FOODS INC N/A false VEND WEST SERVICES N/A false VERITIV N/A false VIKING AUTOMATIC SPRINKER CO N/A false WANKE CASCADE DISTRIBUTION LTD N/A false false false false false false false false false false false false false false false false false false false false