2012-10-12T13:00:06-05:00 2012-01-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2011-02-01 956035137 PRINTING SPECIALTIES AND PAPER PRODUCTS JOINT EMPLOYER & UNION H & W FUND PRIN 2067263251 2323 EASTLAKE AVENUE EAST SEATTLE WA 98102 STEPHEN E NORTHUP 2067263251 2012-10-12 1 KATHLEEN HAAB P01068129 9252779100 2011 2016-02-24 21:20:13Z STEPHEN E NORTHUP 2323 EASTLAKE AVENUE E SEATTLE WA 98102 94839596 0 X N/A X 1952 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. 7 0 0 0 0 0 0 0 55781180 56872969 2269020 1954440 267496 77277 58317696 58904686 0 0 52601955 59105256 0 0 0 0 0 1919927 1921442 54521882 61026698 3795814 -2122012 81099832 81489676 13194405 15580487 67905427 65909189 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 0 0 0 0 1 3131 0 1 0 0 0 0 0 0 0 X 7 0 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 1.00 X 0 0 0 CHARLES RUBLE III 1.00 X 0 0 0 GAYLE SPARAPANI 1.00 X 0 0 0 STEPHEN E NORTHUP 1.00 X 0 0 0 TOM JOLLEY 1.00 X 0 0 0 DAN CABADA 1.00 X 0 0 0 CLARK RITCHEY 1.00 X 0 0 0 0 0 0 0 0 0 0 NORTHWEST ADMINISTRATOR 2323 EASTLAKE AVE EAST SEATTLE WA 981023305 CONTRACT ADMINISTRATOR 671626 DONALDSON CORNWELL 1017 EAST GRAND AVENUE ESCONDIDO CA 92025 ATTORNEY 198182 MILLER KAPLAN ARASE CO LLP 4123 LANKERSHIM BLVD NORTH HOLLYWOOD CA 91602 ACCOUNTANT 178718 BANK OF AMERICA 121 SW MORRISON STREET PORTLAND OR 98207 INVESTMENT MGR AND BANKING 172137 MILLIMAN 650 CALIFORNIA ST 17TH FLOOR SAN FRANCISCO CA 941082702 CONSULTANT 113707 5 EMPLOYER CONTRIBUTIONS 900099 56421713 56421713 SELF-PAY CONTRIBUTIONS 900099 272820 272820 PRESCRIPTION REBATE 900099 110013 110013 COBRA SUBSIDY INCOME 900099 68423 68423 56872969 1882255 1882255 36007095 35934910 72185 72185 72185 LIQUIDATED DAMANGES IN 900099 58637 58637 OTHER INCOME 900099 16125 16125 ANTITRUST LITIGATION I 900099 2515 2515 77277 58904686 56950246 0 1954440 59105256 738060 198761 158310 239370 424881 94317 29385 38358 61026698 0 0 8222087 4323460 5430404 5239664 34833 35334 20484316 21515843 46928192 50375375 81099832 81489676 447909 490487 12746496 15090000 13194405 15580487 X 0 0 0 0 67905427 65909189 67905427 65909189 81099832 81489676 X -2122012 125774 X X 0 1 1 X 0 0 BANK OF AMERICA SHORT DURATION VEBA AND 501(C) COMMON TRUST FUND 50375375 F 50375375 ACCUMULATED ELIGIBILITY CREDITS 9464000 CLAIMS PAYABLE AND IBNR 5626000 15090000 58904686 61026698 -2122012 125774 2343504 2469278 347266 58791090 125774 125774 58665316 239370 239370 58904686 58443824 0 58443824 239370 2343504 2582874 61026698 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 JANUARY 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 NORTHWEST ADMINISTRATORS, INC. TO PROVIDE DAY TO DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED BY THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS. 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 CORRECTION 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 125,774. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF JANUARY 31, 2012, THERE ARE APPROXIMATELY 47 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.