2013-04-09T13:04:25-05:00 2012-08-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2011-09-01 946667029 CALIFORNIA TEACHERS ASSOC EMPLOYEES' HEALTH AND WELFARE BENEFITS TRUST CALI 5032825581 PO BOX 4148 PORTLAND OR 97208 ERIC HEINS 5032825581 2013-04-09 1 KATHLEEN D HAAB P01068129 9252779100 2011 2016-02-25 16:41:14Z ERIC HEINS PO BOX 4148 PORTLAND OR 97208 29331052 0 X N/A X 1993 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 9 0 0 0 0 0 0 0 19175634 20496743 835626 -338984 0 612 20011260 20158371 0 0 20314903 19398691 0 0 0 0 0 1626633 1613437 21941536 21012128 -1930276 -853757 17889400 18231889 1454669 1511786 16434731 16720103 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE ACTIVE AND RETIRED 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 0 1 8 0 1 0 0 0 0 0 0 0 X 9 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X WC EARHART COMPANY INC 5032825581 3140 NE BROADWAY STREET PORTLAND OR 97232 X DEAN VOGEL 2.00 X 0 0 0 ROSEANNE N BECHER 2.00 X 0 0 0 KATIE HOWARD 2.00 X 0 0 0 MERRI BOSTON 2.00 X 0 0 0 CAROLYN DOGGETT 2.00 X 0 0 0 JOHN STEPHENS JR 3.00 X 0 0 0 CHUCK KING 2.00 X 0 0 0 RANNY KRAVETZ 2.00 X 0 0 0 WANDA TURNER 2.00 X 0 0 0 ERIC HEINS 3.00 X 0 0 0 MIKKI CICHOCKI 2.00 X 0 0 0 JIM SCHLOTZ 2.00 X 0 0 0 ROSE LUNA NUNEZ 2.00 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS OF CALIFORNIA 801 S FIGUEROA STREET 5TH FLOOR LOS ANGELES CA 90017 CLAIMS ADMINISTRATION 722979 THE WILLIAM C EARHART COMPANY PO BOX 4148 PORTLAND OR 97208 CONTRACT ADMINISTRATION 187292 HORIZON CONSULTING 6120 ROLLING ROAD DR MIAMI FL 33156 CONSULTING 142652 3 EMPLOYER CONTRIBUTIONS 900099 20070574 20070574 RETIREE MEDICARE SUBSI 900099 307560 307560 PARTICIPANT CONTRIBUTI 900099 118609 118609 20496743 473272 473272 8360425 9172681 -812256 -812256 -812256 OTHER INCOME 900099 612 612 612 20158371 20497355 0 -338984 19398691 183600 49827 49707 25000 1147963 43212 16501 39710 41525 OTHER EXPENSES 16392 21012128 -302044 812839 1442945 8470 1244521 1602148 54353 58710 15449625 15749722 17889400 18231889 155869 178386 1298800 1333400 1454669 1511786 X 0 0 0 0 16434731 16720103 16434731 16720103 17889400 18231889 X -853757 1139129 X X 0 1 1 X 0 0 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 1333400 1333400 20158371 21012128 -853757 1139129 34600 1173729 319972 21272500 1139129 1139129 20133371 25000 25000 20158371 20952528 0 20952528 25000 34600 59600 21012128 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND 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 AUGUST 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 YEARS PRIOR TO 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH W.C. EARHART COMPANY, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE BOARD PRIOR TO FILING. THE BOARD REVIEWED THE FORM 990 WITH THE ADMINISTRATIVE MANAGER. FORM 990, PART VI, SECTION B, LINE 12C IF AND WHEN A POTENTIAL CONFLICT OF INTEREST IS DISCLOSED, THE CONFLICT OF INTEREST OFFICER (ORGANIZATION'S LEGAL COUNSEL) WILL EVALUATE IF THE MATTER WOULD LIKELY PREVENT AN UNBIASED OR OBJECTIVE DECISION BY A TRUSTEE, AND AS APPROPRIATE, DISCLIPINARY OR CORRECTIVE ACTION WILL BE TAKEN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1139129. FORM 990, PART XII, LINCE 2C: THE BOARD OF TRUSTEES HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CALIFORNIA TEACHERS ASSOCIATION EMPLOYEES RETIREMENT BENEFITS 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 680427229 TO PROVIDE RETIREMENT BENEFITS CA 501(A) N/A N/A 0 CALIFORNIA TEACHERS ASSOCIATION 1705 MURCHISON DRIVE BURLINGAME CA 94010 940362310 TO PROMOTE WELL-BEING OF MEMBERS CA 501(C)(5) N/A N/A 0 CALIFORNIA ASSOCIATE STAFF 1118 10TH STREET SACRAMENTO CA 95817 510181184 LABOR ORGANIZATION CA 501(C)(5) N/A N/A 0 CALIFORNIA STAFF ORGANIZATION INC 12210 WATERBROOK DRIVE RANCHO CUCAMONGA CA 91739 954497350 LABOR ORGANIZATION CA 501(C)(5) N/A N/A 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 AUGUST 31, 2012 THERE ARE APPROXIMATELY 50 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.