2012-10-18T10:36:53-05:00 2011-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2011-01-01 936024141 OREGON LABORERS EMPLOYERS HEALTH & WELFARE TR FUND OREG 5032825581 PO BOX 4148 PORTLAND OR 97208 GREG HELD 5032825581 2012-10-18 1 KATHLEEN D HAAB P01068129 9252779100 2011 2016-02-24 21:20:13Z GREG HELD 10245 SE HOLGATE BLVD PORTLAND OR 97266 58146370 0 X N/A X 1954 OR PROVIDE HEALTH AND WELFARE BENEFITS 6 1 42 0 0 0 0 0 19427096 21413197 2399339 1447805 12869 67318 21839304 22928320 0 0 19353293 21617127 0 0 0 0 0 2439210 2489987 21792503 24107114 46801 -1178794 31169979 30181984 9492912 10228119 21677067 19953865 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 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 0 0 0 1 X 5 0 1 42 1 0 0 0 0 0 0 X 6 1 0 1 1 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 X WC EARHART CO 5032825581 3140 NE BROADWAY ST PORTLAND OR 97232 X GREG HELD 0.50 X 0 0 0 DAVE TISCHER 0.50 X 0 0 0 ROBERT OKANO 0.50 X 0 0 0 MIKE SCHIESS 0.50 X 0 0 0 JAMES R WATTS 0.50 X 0 0 0 JEFF HOLLIDAY 0.50 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 1298841 WILLIAM C EARHART CO INC PO BOX 4148 PORTLAND OR 97208 THIRD PARTY ADMINISTRATIVE FEES 234200 COLETT LAW GROUP LLP 1 LINCOLN CENTER 10300 SW GREENBUR PORTLAND OR 97223 LEGAL SERVICES 217564 MERCER HEALTH & BENEFITS 1301 5TH AVENUE SUITE 1900 SEATTLE WA 98101 CONSULTING SERVICES 187331 MANATT PHELPS & PHILLIPS LLP 11355 WEST OLYMPIC BLVD LOS ANGELES CA 90064 LEGAL SERVICES 114906 5 EMPLOYER CONTRIBUTIONS 900099 18614782 18614782 EMPLOYEE CONTRIBUTIONS 900099 2088453 2088453 STOP-LOSS INCOME 900099 244789 244789 PRESCRIPTION REBATES 900099 188718 188718 CMS SUBSIDY REFUND 900099 150530 150530 125925 125925 21413197 221249 221249 36444606 35218050 1226556 1226556 1226556 MISCELLANEOUS INCOME 900099 67318 67318 67318 22928320 21480515 0 1447805 21617127 222325 332899 55617 142597 1563422 36707 11259 37704 NATIONAL HEALTH AND SAF 67468 OTHER EXPENSES 19989 24107114 357175 685691 2144556 2082547 12264 9840 9990269 2417906 18665715 24986000 31169979 30181984 368086 265725 9124826 9962394 9492912 10228119 X 0 0 0 0 21677067 19953865 21677067 19953865 31169979 30181984 X -1178794 -544408 X 0 0 0 0 INVESTMENT TRUST 12968438 F COMMON/COLLECTIVE TRUST FUNDS 12017562 F 24986000 ACCUMULATED ELIGIBILITY CREDITS 7523000 DUE TO RELATED ORGANIZATIONS 826 CLAIMS PAYABLE AND IBNR 2430000 INSURANCE PREMIUMS PAYABLE 8568 9962394 FORM 990, PART V, LINE 2A: THE PLAN PROVIDES TAXABLE DISABILITY BENEFIT PAYMENTS TO ELIGIBLE PARTICIPANTS AND REPORTS THOSE BENEFITS ON FORM W-2. THESE BENEFITS ARE INCLUDED ON FORM 990, PART IX, LINE 4. 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 A, LINE 4 EFFECTIVE JANUARY 1, 2011 THE TRUST AGREEMENT WAS AMENDED TO CREATE A SUBTRUST. THE SUBTRUST ESTABLISHED A RETIREE ONLY PLAN TITLED OREGON LABORERS - EMPLOYERS HEALTH AND WELFARE PLAN FOR RETIREES. THE FINANCIAL ACTIVITY OF THE SUBTRUST IS INCLUDED ON THIS FORM 990 FILING. FORM 990, PART VI, SECTION A, LINE 8B THE BOARD OF TRUSTEES DOES NOT HAVE COMMITTEES THAT ACT ON ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11 A MEMBER OF THE BOARD OF TRUSTEES HAS REVIEWED THE FORM 990 PRIOR TO FILING WITH THE IRS. FORM 990, PART IV, LINE 12: THE OREGON LABORERS EMPLOYERS HEALTH & WELFARE TRUST FUND CONSISTS OF TWO PLANS. THE INDIVIDUAL PLANS HAVE AUDITED FINANCIAL STATEMENTS, HOWEVER THE TRUST DOES NOT. FORM 990, PART VII, LINE 1A THE ORGANIZATION DOES NOT COMPENSATE TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -544,408. OREGON LABORERS - EMPLOYERS PENSION PLAN 3140 NE BROADWAY ST PORTLAND OR 97232 936075363 TO PROVIDE PENSION BENFITS OR 501(A) N/A N/A 0 OREGON LABORERS - EMPLOYERS DEFINED CONTIBUTION AND 401K PLAN 3140 NE BROADWAY ST PORTLAND OR 97232 936075363 TO PROVIDE PENSION BENFITS OR 501(A) N/A N/A 0 OREGON AND SOUTHERN IDAHO LABORERS - EMPLOYERS TRAINING TRUST 3140 NE BROADWAY ST PORTLAND OR 97232 204626312 TO PROVIDE TRAINING BENEFITS OR 501(C)3 N/A N/A 0 IDAHO SIGNATORY EMPLOYERS LABORERS PENSION PLAN 3140 NE BROADWAY ST PORTLAND OR 97232 916145041 TO PROVIDE PENSION BENFITS OR 501(A) N/A N/A 0 OREGON LABORERS ADMINISTRATIVE LLC 3140 NE BROADWAY ST PORTLAND OR 97232 830431313 ADMINISTRATIVE SERVICES OR NA - THERE ARE 3 EQUAL PARTNERS RELATED 78873 30941 0 0 0.33330 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 OREGON LABORERS ADMINISTRATIVE LLC L 77250 OBTAINED FROM THE PLAN'S RECORDS. 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, 2011, THERE ARE APPROXIMATELY 325 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.