2016-10-24T16:36:53-05:00 2015-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2015-01-01 936024141 OREGON LABORERS - EMPLOYERS HEALTH & WELFARE TR FUND OREG 5032825581 3140 NE BROADWAY STREET PORTLAND OR 97232 GREG HELD TRUSTEE 5032825581 2016-10-24 1 KATHLEEN D HAAB P01068129 9252779100 2015 2017-02-10 21:41:12Z GREG HELD 17230 NE SACRAMENTO ST 201 PORTLAND OR 97230 45073232 0 X N/A X 1954 OR PROVIDE HEALTH AND WELFARE BENEFITS 6 1 28 0 0 0 0 0 20424705 20845239 825991 515210 349689 82964 21600385 21443413 0 0 21255139 20820618 0 0 0 0 0 2069932 2017299 23325071 22837917 -1724686 -1394504 24487027 23289604 10467837 11349658 14019190 11939946 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 1 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 5 0 1 28 1 0 0 0 0 0 0 X 6 1 0 1 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 X WC EARHART CO 5032825581 3140 NE BROADWAY ST PORTLAND OR 97232 X GREG HELD TRUSTEE 0.50 X 0 0 0 DAVE TISCHER TRUSTEE 0.50 X 0 0 0 ERIC SNELLING TRUSTEE 0.50 X 0 0 0 ZACK CULVER TRUSTEE 0.50 X 0 0 0 JAMES R WATTS TRUSTEE 0.50 X 0 0 0 MIKE SCHIESS TRUSTEE - PAST 0.50 X 0 0 0 KELLY DIXON TRUSTEE 0.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 X 0 1 0 0 1 0 0 0 0 0 REGENCE BLUE CROSS BLUE SHIELD 100 SW MARKET STREET PORTLAND OR 972015702 CLAIMS ADMINISTRATION 906428 WILLIAM C EARHART CO INC PO BOX 4148 PORTLAND OR 97208 THIRD PARTY ADMINISTRATIVE FEES 253324 OREGON LABORERS-EMPLOYERS ADMIN LLC 3140 NE BROADWAY ST PORTLAND OR 97232 COORDINATOR EXPENSE 181345 MILLIMAN 1301 5TH AVENUE SUITE 1900 SEATTLE WA 98101 CONSULTING SERVICES 124297 4 EMPLOYER CONTRIBUTIONS 900099 18593865 18593865 PARTICIPANT CONTRIBUTIONS 900099 1852367 1852367 PRESCRIPTION REBATES 900099 214667 214667 MEDICARE PART D SUBSIDY 900099 165005 165005 STOP-LOSS INCOME 900099 19335 19335 20845239 247786 247786 23897243 23629819 267424 267424 267424 MISCELLANEOUS INCOME 900099 82964 82964 82964 21443413 20928203 0 515210 20820618 242257 96728 58500 128068 1189227 58215 22854 46585 TRANSITIONAL REINSURANC 107088 NAT'L HEALTH AND SAFETY 64950 OTHER EXPENSES 2827 22837917 486906 411994 1883636 2015720 7688309 7999160 14428176 12862730 24487027 23289604 431659 417482 10036178 10932176 10467837 11349658 X 0 0 0 0 14019190 11939946 14019190 11939946 24487027 23289604 -1394504 -684740 0 X X 0 1 X 1 0 0 COMMON/COLLECTIVE TRUST FUNDS 12862730 F 12862730 ACCUMULATED ELIGIBILITY CREDITS 8927000 CLAIMS PAYABLE AND IBNR 1983600 PREMIUMS PAYABLE 21576 10932176 X 20630605 -684740 -684740 21315345 128068 128068 21443413 21813851 0 21813851 128068 895998 1024066 22837917 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 TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT 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 31,2015, 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 2012. PART XII, 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 A, LINE 8B THE BOARD OF TRUSTEES DOES NOT HAVE COMMITTEES THAT ACT ON ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11 ALL MEMBERS OF THE BOARD OF TRUSTEES REVIEWED THE FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 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, WILLIAM C. EARHART CO. FORM 990, SCHEDULE D, PART XII, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSIGHT OF THE ANNUAL AUDIT AND FOR SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OREGON LABORERS - EMPLOYERS PENSION PLAN 3140 NE BROADWAY ST PORTLAND OR 97232 936075363 TO PROVIDE PENSION BENFITS OR 501(A) N/A N/A 0 OREGON LABORERS-EMPLOYERS DEFINED CONTRIBUTION AND 401(K) PLAN 3140 NE BROADWAY ST PORTLAND OR 97232 276434385 TO PROVIDE PENSION BENFITS OR 501(A) N/A N/A 0 OREGON AND SOUTHERN IDAHO LABORERS - EMPLOYERS TRAINING TRUST 3140 NE BROADWAY ST PORTLAND OR 97232 204626312 TO PROVIDE TRAINING BENEFITS OR 501(C)3 N/A N/A 0 IDAHO SIGNATORY EMPLOYERS LABORERS PENSION PLAN 3140 NE BROADWAY ST PORTLAND OR 97232 916145041 TO PROVIDE PENSION BENFITS OR 501(A) N/A N/A 0 OREGON AND SOUTHERN IDAHO DISTRICT COUNCIL OF LABORERS 17230 NE SACRAMENTO ST 201 PORTLAND OR 97230 930144236 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 LABORERS INTERNATIONAL UNION LOCAL 483 1125 SE MADISON ST SUITE 206 PORTLAND OR 97214 930169132 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 LABORERS LOCAL NO 320 PO BOX 16790 PORTLAND OR 97292 930173215 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 LABORERS INTERNATIONAL UNION NO 296 4545 NE 102ND AVE PORTLAND OR 97220 930188805 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 LABORERS UNION LOCAL 155 465 W 17TH ST IDAHO FALLS ID 83402 820411490 LABOR ORGANIZATION ID 501(C)5 N/A N/A 0 LABORERS INTERNATIONAL UNION OF NORTH AMERICA 121 265 SE SCOTT ST BEND OR 97702 930958230 LABOR ORGANIZATION OR 501(C)5 N/A N/A 0 OREGON LABORERS ADMINISTRATIVE LLC 3140 NE BROADWAY ST PORTLAND OR 97232 830431313 ADMINISTRATIVE SERVICES OR NA - THERE ARE 3 EQUAL PARTNERS RELATED 121507 55892 0 0 0.33330 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 OREGON LABORERS ADMINISTRATIVE LLC M 181345 OBTAINED FROM THE PLAN'S RECORDS. SCHEDULE R, PART II THROUGH IV (CONTINUED): R & R GENERAL CONTRACTORS RDF BUILDERS CO REDI SERVICE, LLC REFRACTORY SERVICES INC, RICE LLC MASONRY RIO UNDERGROUND CONST LLC RIVERS WEST CONSTRUCTION RIVERVIEW CEMETERY ASSOC ROBERTSON HAY & WALLACE ROCKFORD CORP ROGERS ADMINISTRATION INC ROSE CITY CEMETERY ROSEBURG FOREST PRODUCTS ROSS ISLAND SAND & GRAVEL S & B JAMES CONST CO SAFWAY SERVICES LLC SAK & ASSOCIATES SAK CONSTRUCTION, LLC SALUTE INCORPORATED SCAFFOLD ERECTORS INC SCARSELLA BROS INC SCHEFFLER NW INC SDB CONTRACTING SERVICES SHEEHAN PIPE LINE SIERRA NEVADA CONSTRUCTIO SKANSKA USA BLDG INC SKYLINE MEMORIAL GARDENS SLAYDEN SUNDT JV SNELSON CO SOUTHERN CA LABORERS HW/P SPACESAVER SPECIALISTS ST JOSEPH'S PRECISION PRE STACEY & WITBECK INC STANDARD UTILITY CONTRACT STAR CONSTRUCTION SERV STEBBINS ENGINEERING CORP SUNDOWN ELECTRIC CO SUNROC CONSR CO INC SUPERIOR GUNITE SUSTAINABLE FLOORING SOL. SWINERTON BUILDERS T GERDING CONSTRUCT CO TBH & ASSOCIATES LLC TEUFEL NURSERY INC THE CITY OF AMITY THE CITY OF DRAIN TITAN UTILITIES LLC TOWN & COUNRY FENCE CO. TRIAD MECHANICAL TURNER CONSTRUCTION CO U.S. PIPELINE UNIVERSITY MECHANICAL CON UPRIGHT SHORING UTAH LABORERS VAN LOM CONCRETE INC VAN ZANT CONST LLC VIGOR MARINE VIKING ENGINEERING & CONS VOITH HYDRO INC W W CLYDE & CO WALDRON & SONS INC WALLTEK CONSTRUCTION LLC WARD HENSHAW CONST CO INC WEITMAN EXCAVATION WESTERN CONSTRUCTION INC WESTERN PARTITIONS INC WFJ JANITORIAL SERVICES WHITAKER/ELLIS BUILDERS WHITE CONSTRUCTION INC WILDISH BUILDING CO WILDISH CONSTRUCTION CO WILDISH STANDARD PAVING C WILLAMETTE FENCE CO INC WM DICKSON CO WOLVERINE CANYON CONSTRUC ZAVALA CORPORATION INC SCHEDULE R, PART II THROUGH IV IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILLING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF DECEMBER 31, 2015, THERE ARE APPROXIMATELY 294 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 EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. 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