2015-10-13T14:37:58-05:00 2015-01-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2014-02-01 956035137 PRINTING SPECIALTIES AND PAPER PRODUCTS JOINT EMPLOYER & UNION H & W FUND PRIN 2067263251 2323 EASTLAKE AVENUE EAST SEATTLE WA 98102 STEPHEN E NORTHUP TRUSTEE 2067263251 2015-10-13 1 KATHLEEN HAAB P01068129 9252779100 2014 2016-02-25 16:41:14Z STEPHEN E NORTHUP 2323 EASTLAKE AVENUE E SEATTLE WA 98102 67929293 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 57166761 57538339 995666 1021441 13331 3392 58175758 58563172 0 0 59506984 55688712 0 0 0 0 0 1933875 2100272 61440859 57788984 -3265101 774188 74930060 78482102 14959214 17139845 59970846 61342257 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 2524 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 SCHED O FOR COMPENSATION PAID BY RELATED ORGANIZATI 1.00 X 0 1 0 0 1 0 0 0 0 0 NORTHWEST ADMINISTRATORS INC 2323 EASTLAKE AVE EAST SEATTLE WA 981023305 CONTRACT ADMINISTRATOR 648413 BLUE SHIELD OF CALIFORNIA 2175 N CALIFORNIA AVE STE 250 WALNUT CREEK CA 94596 CLAIMS ADMINISTRATOR 220157 DONALDSON & CORNWELL 1017 EAST GRAND AVENUE ESCONDIDO CA 92025 ATTORNEY 211348 MILLIMAN INC 650 CALIFORNIA ST NO 17 SAN FRANCISCO CA 94108 CONSULTING 162929 LINDQUIST LLP 9725 3RD AVE NE STE 603 SEATTLE WA 98115 ACCOUNTANT 153273 6 EMPLOYER CONTRIBUTIONS 900099 55569874 55569874 STOP LOSS REIMBURSEMENTS 900099 1356317 1356317 PRESCRIPTION REBATE 900099 447258 447258 SELF-PAY CONTRIBUTIONS 900099 164890 164890 57538339 1285689 1285689 9101873 9366121 -264248 -264248 -264248 LIQUIDATED DAMAGES & INTEREST 900099 3392 3392 3392 58563172 57541731 0 1021441 55688712 679393 213138 149424 230182 484283 118141 33639 38788 ACA - REINSURANCE FEES 150091 ACA - PCORI FEES 3193 57788984 0 0 5726111 8266840 4639760 5942487 34916 42020 21978718 23451648 42550555 40779107 74930060 78482102 836214 958245 14123000 16181600 14959214 17139845 X 0 0 0 0 59970846 61342257 59970846 61342257 74930060 78482102 774188 597223 0 X X 0 1 X 1 0 0 BANK OF AMERICA SHORT DURATION VEBA AND 501(C) COMMON TRUST FUND 40779107 F 40779107 ACCUMULATED ELIGIBILITY CREDITS 9002000 CLAIMS PAYABLE AND IBNR 7179600 16181600 X 58930213 597223 597223 58332990 230182 230182 58563172 55500202 0 55500202 230182 2058600 2288782 57788984 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, 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 ORGANIZATION HAS CONTRACTED WITH NORTHWEST ADMINISTRATORS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE ADMINISTRATION 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 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 ADMINISTRATORS, NORTHWEST ADMINISTRATOR,INC. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES HAS 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 2) THARCO - 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 1) MOREL COMMUNICATIONS NATIONAL PRINTING COMPANY NEVADA DENTAL BENEFITS LIMITED GEORGIA PACIFIC-BUENA PARK GEORGIA PACIFIC-MODESTO INTERNATIONAL PAPER (BEAVERTONBAG) INTERNATIONAL PAPER (COMPTON) INTERNATIONAL PAPER (MODESTO) INTERNATIONAL PAPER (MOSES LAKE) INTERNATIONAL PAPER (OLYMPIA) INTERNATIONAL PAPER - CAMARILLO PLANT INTERNATIONAL PAPER (ELK GROVE SACRAM) INTERNATIONAL PAPER (TRACY) INTERNATIONAL PAPER (YAKIMA) IRWIN-HODSON GROUP LLC THARCO - COLORADO EMPLOYEES THARCO (CORRUGATORWAREHOUSE) THARCO (SHEET) 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, 2015, THERE ARE APPROXIMATELY 58 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 17 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. CORRUGATED PACKAGING PRODUCTS GREIF, INC. HOUSE OF PRINTING, INC. LA PAPER BOX MERCURY CONTAINER PACIFIC PAPER BOX CO, PACIFIC PRINTING RAPID DISPLAYS ROCKTENN (CORONA) ROCKTENN (MILPITAS) ROCKTENN (PORTLAND) ROCKTENN (SALINAS) ROTARY OFFSET PRESS ROYAL PAPER BOX SERVICE PRESS, INC SERVICE PRINTING SILICON VALLEY CONTAINER