2013-10-10T14:11:27-05:00 2012-12-31 MILLER KAPLAN ARASE LLP 4123 LANKERSHIM BLVD NORTH HOLLYWOOD CA 916022828 990 2012-01-01 936042567 Portland Area UFCW Local 555- Employers Health Plan % PATI PIRO-BOSLEY PORT 8006544411 7600 SW MOHAWK ST Suite TUALATIN OR 970628121 pati piro-bosely 8006544411 2013-10-07 true MILLER KAPLAN ARASE LLP 8187692010 2012 2016-02-25 16:41:14Z SCOTT POWERS 7600 SW MOHAWK ST TUALATIN OR 970628121 87410795 false X N/A X 1957 OR SEE SCHEDULE O 10 0 5 0 0 0 0 81099673 84358207 20622 95464 0 0 81120295 84453671 0 0 81194347 73874396 0 0 0 0 0 1172204 1086145 82366551 74960541 -1246256 9493130 20346257 29285046 19060172 18434886 1286085 10850160 X SEE SCHEDULE O false false SEE SCHEDULE O false false false false false false false false false false false false false true true 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 591 0 true 5 true false false false false false false X 10 0 false true false false false false false true true false false true true true true true true false X PATI PIRO-BOSLEY 8006544411 7600 SW MOHAWK ST TUALATIN OR 970628121 X X Jeff Anderson 1.0 X 0 0 0 dAn clay 1.0 X 0 0 0 matt smith 1.0 X 0 0 0 lisa dupell 1.0 X 0 0 0 BRENT BOHN 1.0 X 0 0 0 FRANK JORGENSEN 1.0 X 0 0 0 KEVIN BILLMAN 1.0 X 0 0 0 scott powers 1.0 X 0 0 0 cynthia thornton 1.0 X 0 0 0 lynda hart 1.0 X 0 0 0 0 0 0 0 false false false REGENCE BLUECROSS BLUESHIELD of ore PO BOX 1271 M/S ELLA PORTLAND OR 97207 PPO PROVIDER ADMIN. 4452928 EXPRESS SCRIPTS PO BOX 390873 BLOOMINGTON MN 55439 CLAIMS COST CONTROL 414026 2 0 EMPLOYER CONTRIBUTIONS 900099 78941202 78941202 PARTICIPANT CONTRIBUTIONS 900099 5417005 5417005 84358207 106530 106530 0 0 0 0 0 2946058 2957124 -11066 -11066 -11066 0 0 0 0 84453671 84358207 95464 0 0 0 73874396 0 0 0 0 0 0 650261 25800 61413 0 0 15721 196216 0 84892 0 0 0 0 0 15262 0 0 0 36580 74960541 7614702 16449271 0 0 0 0 7952953 7800222 0 0 0 0 0 0 0 0 35347 34010 0 4743255 5001543 0 0 0 0 0 0 0 0 20346257 29285046 64983 111487 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18995189 18323399 19060172 18434886 X 0 0 0 0 1286085 10850160 1286085 10850160 20346257 29285046 X 9493130 70945 X false true X true 0 CLAIMS INCURRED BUT NOT REPORTED 7149000 ACCUMULATED ELIGIBILITY CREDITS 11174399 18323399 X 84524616 70945 70945 84453671 84453671 75632331 75632331 -671790 -671790 74960541 part x, line 2: The Plan has adopted guidance on accounting for uncertainty in income taxes issued by the Financial Accounting Standards Board. The Plan administrator believes that the Plan has taken no uncertain tax positions that require adjustment to the financial statements to comply with the provisions of this guidance. Certain Information returns are subject to examination by authorities. part xiI, line 4b: ADJUSTMENTS FOR BENEFITS PAID FROM ACCRUAL BASIS (FORM 990) TO CASH basis (FINANCIAL STATEMENTS) = $671,790. PART I, LINE 1 AND PART III, LINE 1 - ORGANIZATION'S MISSION: TO PROVIDE MEDICAL, VISION, DENTAL, PRESCRIPTION, SUPPLEMENTAL INCOME, LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS TO PARTICIPANTS ON WHOSE BEHALF EMPLOYERS CONTRIBUTE TO THE PLAN IN ACCORDANCE WITH THEIR COLLECTIVE BARGAINING AGREEMENT. PART VI, LINE 11b: FORM 990 WAS REVIEWED BY THE ADMINISTRATIVE OFFICE PRIOR TO FILING. ANY UNUSUAL ITEMS WERE BROUGHT TO THE TRUSTEES ATTENTION. PART VI, LINE 12C: TRUSTEES ARE REQUIRED TO NOTIFY THE TRUST OF ANY CHANGES IN THEIR INTERESTS THAT COULD GIVE RISE TO CONFLICTS. PART VI, LINE 19: THE TRUST DOCUMENT, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED IN THE TRUSTS' OFFICE AND ARE AVAILABLE UPON REQUEST. PART VII, SECTION A: ANY TRUSTEES' OR DIRECTORS' COMPENSATION AND/OR BENEFITS FROM RELATED TAX-EXEMPT ORGANIZATIONS IS PROPERLY REPORTED AND AVAILABLE ON THOSE ORGANIZATIONS' FORM 990. BENNETT HARTMAN MORRIS&KAPLAN 210 SW MORRISON ST 500 PORTLAND OR 97204 930633539 HEALTH INSURANCE OR MCKANNA BISHOP & JOFFE 1635 NW JOHNSON PORTLAND OR 97209 931304398 LEGAL SERVICES OR false false false false false false false false false false false false false false false false false false false SCHEDULE R - IDENTIFICATION OF RELATED-PARTY ORGANIZATIONS: THIS INFORMATION IS NOT MAINTAINED BY THE ADMINISTRATIVE OFFICE. IF SPECIFIC INFORMATION IS NEEDED, PLEASE CONTACT THE ADMINISTRATIVE OFFICE.