2017-12-01T10:54:24-06:00 2017-01-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2016-02-01 956035137 PRINTING SPECIALTIES AND PAPER PRODUCTS JOINT EMPLOYER AND UNION H&W FUND PRIN 2067263251 2323 EASTLAKE AVENUE EAST SEATTLE WA 98102 STEPHEN E NORTHUP TRUSTEE 2067263251 2017-12-01 1 JAMES N BROWNING P01451906 9252779100 66.7.226.66 2017-12-01 08:54:12 PS P 7DD7D651EED3271A1BC43F77E46D70BE1B99B049 AF0F784E429982BC93A0FAF5EDF9664BBECC31B5 2016 2017-02-10 21:41:12Z STEPHEN E NORTHUP 2323 EASTLAKE AVENUE E SEATTLE WA 98102 305483481 0 X N/A X 1952 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. 6 1 0 0 0 0 0 0 60368149 60803634 1236421 2259494 0 0 61604570 63063128 0 0 54655871 59851754 0 0 0 0 0 2060635 1986568 56716506 61838322 4888064 1224806 78984738 85956979 13830970 21008849 65153768 64948130 PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 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 1 2514 0 1 0 0 0 0 0 0 0 X 6 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X NORTHWEST ADMINISTRATORS INC 2063294900 2323 EASTLAKE AVE EAST SEATTLE WA 981023305 X LEASHA BAILEY TRUSTEE 1.00 X 0 0 0 CLARK RITCHEY TRUSTEE 1.00 X 0 0 0 GAYLE SPARAPANI TRUSTEE & SECRETARY 1.00 X 0 0 0 STEPHEN E NORTHUP TRUSTEE & CHAIRMAN 1.00 X 0 0 0 THOMAS SARNECKI TRUSTEE 1.00 X 0 0 0 DAN CABADA TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 1 0 0 1 0 0 0 0 0 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVE EAST SEATTLE WA 981023305 CONTRACT ADMINISTRATOR 697219 BLUE SHIELD OF CALIFORNIA 2175 N CALIFORNIA AVE STE 250 WALNUT CREEK CA 94596 CLAIMS ADMINISTRATOR 230356 CORNWELL & BALDWIN 1017 EAST GRAND AVENUE ESCONDIDO CA 92025 ATTORNEY 212257 LINDQUIST LLP 9725 3RD AVE NE STE 603 SEATTLE WA 98115 ACCOUNTANT 181236 MILLIMAN INC 650 CALIFORNIA ST NO 17 SAN FRANCISCO CA 94108 CONSULTING 138820 5 EMPLOYER CONTRIBUTIONS 900099 59795137 59795137 STOP LOSS REIMBURSEMENTS 900099 762877 762877 PRESCRIPTION REBATE 900099 209347 209347 SELF-PAY CONTRIBUTIONS 900099 28612 28612 LIQUIDATED DAMAGES 900099 7661 7661 60803634 1086854 1086854 243592993 242420353 1172640 1172640 1172640 63063128 60803634 0 2259494 59851754 724765 205768 177988 196688 409918 95285 42820 38083 ACA - REINSURANCE FEES 89302 ACA - PCORI FEES 5951 61838322 8874167 8333666 5842082 7214716 35218 33525 23407970 70375072 40825301 0 78984738 85956979 812470 3264849 13018500 17744000 13830970 21008849 X 0 0 0 0 65153768 64948130 65153768 64948130 78984738 85956979 1224806 -1430444 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 9105000 CLAIMS PAYABLE AND IBNR 8639000 17744000 X 61435996 -1430444 -1430444 62866440 196688 196688 63063128 56916134 0 56916134 196688 4725500 4922188 61838322 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF JANUARY 31, 2017, 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 FISCAL YEARS PRIOR TO 2014. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH NORTHWEST ADMINISTRATORS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE ADMINISTRATIVE OFFICE REVIEWS THE FORM 990 AND WILL NOTIFY THE BOARD OF TRUSTEES IF ANY UNUSUAL OR SIGNIFICANT ITEMS ARE NOTED. THE TRUST CHAIRMAN AND SECRETARY REVIEW THE FORM 990 PRIOR TO PROVIDING SIGNATURES. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF TRUSTEES ARE COVERED BY THE CONFLICT-OF-INTEREST POLICY. IF AND WHEN A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE BOARD OF TRUSTEES WILL INVOLVE THE TRUST'S ATTORNEY TO EVALUATE IF THE MATTER WOULD LIKELY PREVENT AN UNBIASED OR OBJECTIVE DECISION BY A TRUSTEE. AS APPROPRIATE, DISCIPLINARY OR CORRECTIVE ACTION WILL BE TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED BY THE ADMINISTRATIVE OFFICE AND ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, NORTHWEST ADMINISTRATORS, INC. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES HAVE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. ALLIED PRINTING CO CA TEAMSTERS DISTRICT COUNCIL NO 2 710 E COMMONWEALTH AVENUE FULLERTON CA 92831 951296250 LABOR ORGANIZATION CA 501(C)5 N/A N/A 0 NEWSPAPER AGENCY CO LLC AABCO PRINTING AUTOMATIC PRINTING CO CORRU-KRAFT II HOLLY PRESS INTERNATIONAL PAPER (BEAVERTON CORRUG) INTERNATIONAL PAPER (BUENA PARK) KP CORPORATION (SEATTLE) KAPSTONE (IDAHO) MISSION CORRUGATED PACKAGING CORP OF AMERICA SUBURBAN PRESS PACKAGING CORP OF AMERICA - SAN LORENZO EMPLOYEES US INK - A DIVISION OF SUN CHEMICALS NORTHGATE TERRACE - GCIU INC GEORGIA PACIFIC-OLYMPIA GEORGIA PACIFIC-SAN LEANDRO HOLLYWOOD IMPRESS CHIMES PRINTING DAILY JOURNAL OF COMMERCE IRWIN-HODSON RUBBER STAMP MOREL COMMUNICATIONS NATIONAL PRINTING COMPANY GEORGIA PACIFIC-BUENA PARK GEORGIA PACIFIC-MODESTO INTERNATIONAL PAPER (BEAVERTONBAG) INTERNATIONAL PAPER (COMPTON) INTERNATIONAL PAPER (SALINAS) INTERNATIONAL PAPER (MOSES LAKE) INTERNATIONAL PAPER (OLYMPIA) INTERNATIONAL PAPER (ELK GROVE SACRAM) IRWIN-HODSON GROUP LLC PACKAGING CORP OF AMERICA - COLORADO EMPLOYEES PACKAGING CORP OF AMERICA (CORRUGATORWAREHOUSE) PACKAGING CORP OF AMERICA (SHEET) KAPSTONE (OAKLAND) KAPSTONE (YAKIMA) INTERNATIONAL PAPER (RIVERSIDE) INTERNATIONAL PAPER (SANTA FE SPRINGS) INTERNATIONAL PAPER (SANTA PAULA & CAMARILLO) INTERNATIONAL PAPER (YAKIMA) INTERNATIONAL PAPER (CROCKETT CONTAINER CORP) CORRU-KRAFT IV GREIF INC HOUSE OF PRINTING INC LA PAPER BOX & BOARD MERCURY CONTAINER PACIFIC PRINTING (BU & NBU) RAPID DISPLAYS ROTARY OFFSET PRESS ROYAL PAPER BOX SERVICE PRESS INC 0 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 EMPLOYERS AND THEIR DEPENDENTS. AS OF JANUARY 31, 2017, THERE ARE APPROXIMATELY 62 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR APPROXIMATELY 8 CONTRIBUTING EMPLOYERS IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS FOR WHICH THE ADMINISTRATIVE OFFICE HAS THE FEDERAL TAX CLASSIFICATION ARE LISTED ON PART II AND THROUGH IV, AND THE REMAINING CONTRIBUTING EMPLOYERS ARE LISTED BELOW IN PART VII. CARUSTAR CUSTOM PKG MANUFACTURED PACKAGING RADIANT COLOR CO/MAG SERVICE PRINTING COM WESTROCK (CORONA) WESTROCK (MILPITAS) WESTROCK (PORTLAND) WESTROCK (SALINAS)