2013-10-18T14:52:43-05:00 2012-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2012-01-01 936021475 OREGON TEAMSTER EMPLOYERS TRUST OREG 5032825581 PO BOX 4148 PORTLAND OR 972084148 STEPHEN S ERDMANN 5032825581 2013-10-18 1 KATHLEEN D HAAB P01068129 9252779100 2012 2016-02-24 21:20:13Z STEPHEN S ERDMANN PO BOX 4148 PORTLAND OR 972084148 233244839 0 X N/A X 1957 OR TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 12 3 0 0 0 0 0 0 157327779 148434689 1205223 1493675 83996 23086 158616998 149951450 0 0 139015467 130957815 0 0 0 0 0 7871019 7210698 146886486 138168513 11730512 11782937 62838561 75462541 24635661 24684664 38202900 50777877 PROVIDE HEALTH, DENTAL, VISION, LIFE INSURANCE AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 PROVIDED HEALTH, DENTAL, VISION, LIFE INSURANCE AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS. 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 5 0 1 0 0 0 0 0 0 0 X 12 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE WILLIAM C EARHART CO INC 5032825581 3140 NE BROADWAY STREET PORTLAND OR 97232 X DAN RATTY 1.00 X 0 0 0 STEVE PICKLE 1.00 X 0 0 0 GREG BAXTER 1.00 X 0 0 0 JOHN SILVA 1.00 X 0 0 0 TOM WATT 1.00 X 0 0 0 STEPHEN ERDMANN 1.00 X 0 0 0 CARL WOJCIECHOWSKI 1.00 X 0 0 0 JENNIFER MONTGOMERY 1.00 X 0 0 0 ADAM WINSTON 1.00 X 0 0 0 JERRY D'AMBROSIO 1.00 X 0 0 0 BOB SLEIGHT 1.00 X 0 0 0 KENNETH JOHNSON 1.00 X 0 0 0 0 0 0 0 0 0 0 REGENCE BLUE CROSS BLUE SHIELD 100 SW MARKET STREET PORTLAND OR 972015702 CLAIMS ADMINISTRATION 5397810 EXPRESS SCRIPTS INC 1 EXPRESS SCRIPTS WAY ST LOUIS MO 63121 PRESCRIPTION PROCESSING 856518 WILLIAM C EARHART CO INC 3140 NE BROADWAY ST PORTLAND OR 97232 THIRD PARTY ADMINISTRATIVE FEES 775806 SCRIBNER SCRIBNER & SUTTON 1523 NE 6TH AVENUE PORTLAND OR 97232 PAYROLL AUDITS 166575 LOOMIS SAYLES & COMPANY LP 555 CALIFORNIA STREET SUITE 3300 SAN FRANCISCO CA 94104 INVESTMENT MANAGEMENT 160332 7 EMPLOYER CONTRIBUTIONS 900099 137560007 137560007 PARTICIPANT CONTRIBUTIONS 900099 7017344 7017344 PRESCRIPTION REBATES 900099 2515851 2515851 MEDICARE PART D SUBSIDY 900099 529959 529959 HRA CONTRIBUTIONS 900099 451259 451259 360269 360269 148434689 1351550 1351550 83435514 83293389 142125 142125 142125 OTHER INCOME 900099 23086 23086 23086 149951450 148434689 0 1516761 130957815 780403 184103 204236 179748 5634618 118618 36313 72659 138168513 4383212 245889 886455 13410347 13408846 45045002 60921351 62838561 75462541 624801 689277 531535 522292 23479325 23473095 24635661 24684664 X 0 0 0 0 38202900 50777877 38202900 50777877 62838561 75462541 11782937 792040 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE AND IBNR 11729000 PREMIUMS PAYABLE 1119095 ACCUMULATED ELIGIBILITY CREDITS 10625000 23473095 X 150563742 792040 792040 149771702 179748 179748 149951450 137994995 0 137994995 179748 -6230 173518 138168513 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. THE PLAN HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2012, 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 2009. 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 B, LINE 11 THE FORM 990 IS PROVIDED TO THE GOVERNING BODY FOR THEIR REVIEW AND COMMENTS PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY TRUSTEE OR SERVICE PROVIDER AUTHORIZED TO CONDUCT TRANSACTIONS ON BEHALF OF THE TRUST WHO HAS REASON TO BELIEVE THAT A PROPOSED TRANSACTION MIGHT CONSTITUTE A PROHIBITED TRANSACTION WITH A PARTY IN INTEREST SHOULD CONSULT WITH TRUST COUNSEL AND TAKE WHATEVER ADDITIONAL ACTION MAY BE APPROPRIATE TO ENSURE THAT THE PROPOSED TRANSACTION IS APPROPRIATE. ANY FIDUCIARY WHOSE PARTICIPATION IN A DECISION MAY RESULT IN A NON-EXEMPTED PROHIBITED TRANSACTION UNDER SECTION 406 OF ERISA SHALL RECUSE HIMSELF OR HERSELF FROM DISCUSSION OR VOTING ON SUCH DECISION. THE TRUST OFFICE SHALL ANNUALLY DISTRIBUTE A PARTY-IN-INTEREST QUESTIONNAIRE TO PLAN FIDUCIARIES IN CONJUNCTION WITH THE ANNUAL AUDIT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSIGHT OF THE ANNUAL AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. JOINT COUNCIL OF TEAMSTERS NO 37 1872 NE 162ND AVENUE PORTLAND OR 97230 930196193 LABOR ORGANIZATION OR 501(C)(5) 0 INT'L BROTHERHOOD OF TEAMSTERS UNION LOCAL NO 962 4480 ROGUE VALLEY HGWY CENTRAL POINT OR 97502 930236781 LABOR ORGANIZATION OR 501(C)(5) 0 GENERAL TEAMSTERS LOCAL 483 225 N 16TH STREET BOISE ID 83702 820171930 LABOR ORGANIZATION ID 501(C)(5) 0 INTL BROTHERHOOD OF TEAMSTERS LOCAL 324 2686 PORTLAND ROAD NE SALEM OR 97303 930196206 LABOR ORGANIZATION OR 501(C)(5) 0 DAIRY BAKERY & FOOD PROCESSORS IND TECH & AUTO LOCAL NO 305 1870 NE 162ND AVENUE PORTLAND OR 97230 930151383 LABOR ORGANIZATION OR 501(C)(5) 0 INTL BROTHERHOOD OF TEAMSTERS LOCAL 223 1230 NE 106TH AVENUE PORTLAND OR 97220 930179776 LABOR ORGANIZATION OR 501(C)(5) 0 GENERAL TEAMSTERS AUTO TRUCK DRIVERS & HELPERS LOCAL 162 1850 NE 162ND AVENUE PORTLAND OR 97230 930196219 LABOR ORGANIZATION OR 501(C)(5) 0 LINE DRIVERS LOCAL PICKUP & DELIVER LOCAL UNION NO 81 1874 NE 162ND AVENUE PORTLAND OR 97230 930438697 LABOR ORGANIZATION OR 501(C)(5) 0 CHAUFFEURS TEAMSTERS & HELPERS LOCAL 58 2212 NE ANDRESEN ROAD VANCOUVER WA 98661 910436963 LABOR ORGANIZATION WA 501(C)(5) 0 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 EMPLOYEES AND THEIR DEPENDENTS. AS OF DECEMBER 31, 2012, THERE ARE APPROXIMATELY 187 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. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. ALBINA FUEL CO ALLIED WASTE INDUSTRIES ALPENROSE DAIRY ALSCO AMERICAN INDUSTRIAL AMERICAN METALS CORP ARAMARK CLEAN ROOM ARAMARK UNIFORM SERVICES ARROW SANITARY SERV INC B & B LEASING BIMBO BAKERIES USA, INC BLACK BUTTE RANCH FIRE BLACK BUTTE RANCH POLICE BLISS SANITARY SEVICE INC BLUELINX CORPORATION CAPITOL DISPOSAL & RECYLE CARBONIC SYSTEMS INC CENEX HARVEST STATES(CHS) CHRISTENSEN ELECTRIC CO CHRISTENSON OIL CITY OF ASTORIA POLICE CITY OF BANDON CITY OF BROOKINGS CITY OF CENTRAL POINT CITY OF CLATSKANIE-POLICE CITY OF COQUILLE CITY OF CORVALLIS-POLICE CITY OF EAGLE POINT CITY OF FAIRVIEW CITY OF GRANTS PASS CITY OF INDEPENDENCE CITY OF JACKSONVILLE CITY OF KALAMA CITY OF KELSO CITY OF KLAMATH FALLS CITY OF LEBANON CITY OF MEDFORD CITY OF MOLALLA CITY OF NORTH BEND CITY OF ONTARIO CITY OF PHOENIX CITY OF RAINIER CITY OF REEDSPORT CITY OF RIDGEFIELD CITY OF ROGUE RIVER CITY OF SHADY COVE CITY OF TALENT CITY OF TILLAMOOK-POLICE CLACKAMAS GARBAGE CO INC CLATSOP DISTRIBUTING CO CLEAN WATER SERVICES COAST AUTO SUPPLY CO COLUMBIA FRUIT & PRODUCE COLUMBIA STORAGE INC CONTAINER MANAGEMENT,LLC COPELAND PAVING COMPANY COUNTY OF COOS COUNTY OF TILLAMOOK COWLITZ COUNTY AUDITOR CURRY COUNTY SHERIFFS DAIMLER TRUCKS N. AMERICA DHL EXPRESS DOUGLAS COUNTY EBS ASSOCIATES INC ECSO EMERALD FRUIT & PRODUCE ESTENSON LOGISTICS FRED MEYER FRED MEYER CREDIT UNION GARBARINO DISPOSAL SERV GENERAL CHEMICAL CORP GRANGE COOP SUPPLY ASSN GREAT WESTERN MALTING CO GRESHAM SANITARY SERVICE HAZELNUT GROWERS OF OR HILLSBORO GARB DISP INC HILTON HOTEL PARKING HOLMAN DISTRIBUTION CTR INDUSTRIAL EXPORT CO INTERSTATE BRANDS KELLER DROP BOX INC / KINGS COUNTY TRUCK LINES KLAMATH CO EMERGENCY COMM KLAMATH COUNTY SERGEANTS L C HALLS TRUCK LINES LA GRAND INDUSTRIAL SUPP LAKE COUNTY LAKE DISTRICT HOSPITAL LAKE MERWIN CAMPER HIDEWA LAND O LAKES INC LARSEN OIL COMPANY INC LARSENS CREAMERY LEE & EASTES TANK LINES LEMMONS TRUCKING CO INC MATHESON TRI-GAS INC. MAVERICK WELDING SUPPLIES MCMINNVILLE FARMERS CO-OP MERCY FLIGHTS INC MILLER SANITARY SERV INC MORROW COUNTY MULTNOMAH COUNTY DROP BOX MUTUAL MATERIALS CO NABISCO INC NELSON TRUCKING COMPANY NORPAC SERVICES INC NORTHWEST PACKING CO NORTHWEST VENDING CO NU STAR ENERGY NW ADMINISTRATORS INC NW EMPLOYEE BENEFITS OCEAN BEACH HOSPITAL OREGON NURSES ASSOCIATION OREGON TRANSFER CO PENDLETON SANITARY SERVIC PENSKE TRUCK LEASING CO PEPSI COLA BOTTLING CO PERFECT FIT-MCDONALD INC PORTLAND BEVERAGE CO PORTLAND HOSPITAL SERVICE PRAXAIR INCORPORATED PRIDE DISPOSAL COMPANY PROFESSIONAL MECHANICAL R A THAYER TRUCKING RAPID TRANSFER & STORAGE REDDAWAY TRUCK LINE INC RESOURCE MGMT SERVICE RHODIA INC RIVERSIDE READY MIX RIVERVIEW ABBEY ROCKFORD CORPORATION ROGUE VALLEY SEWER SERV RUAN TRANSPORT CORP SAFEWAY EMPLOYEE SERV CTR SALEM BRAKE & WHEEL INC SANIPAC INC SMART & FINAL STORES CORP SPICERS PAPER INC STEINER CORPORATION SUNSET GARBAGE SUNSHINE DAIRY FOODS SWARTZ MOVING & STORAGE SWATCO SANITARY SERVICE SYSCO PORTLAND, INC TAITS MAINTENANCE CO INC TELEIOS INC THE HERTZ CORPORATION TILLAMOOK COUNTY TILLAMOOK COUNTY CREAMERY TOWN OF LAKEVIEW-GENERAL TOWN OF LAKEVIEW-POLICE TP FREIGHT LINES INC U S TRANSFER CO INC UNIFIED WESTERN GROCERS UNITED PARCEL SERVICE INC UNITED STATES BAKERY UNITED WAREHOUSE UNIVAR USA INC US FOOD SERVICE VAN DUSEN BEVERAGES INC VANCOUVER ICE & FUEL OIL VEND WEST SERVICES INC VENTURA FOODS WALKER GARBAGE SERV INC WASHINGTON CO DROP BOX WASTE CONNECTIONS INC WASTE MANAGEMENT WEITZELS GARBAGE SERVICE WESTCO PRODUCTS COMPANY WESTFARM FOOD (DARIGOLD) WILHELM TRUCKING ACQUISIT WILLIAM C EARHART COMPANY WILLIAMS BAKERY WINCO FOODS LLC-WOODBURN WOODLAND TRUCK LINE INC XPEDX YAMHILL COUNTY YRC INC.