2012-06-22T18:37:38-04:00 2011-12-31 MILLER KAPLAN ARASE & CO LLP 4123 LANKERSHIM BLVD NORTH HOLLYWOOD CA 916022828 990 2011-01-01 936042567 Portland Area UFCW Local 555- Employers Health Plan % PATI PIRO-BOSLEY PORT 8006544411 7600 SW MOHAWK ST TUALATIN OR 970628121 PATI PIRO-BOSLEY 2012-06-22 true MILLER KAPLAN ARASE CO LLP 8187692010 2011 2016-02-24 21:20:13Z SCOTT POWERS 7600 SW MOHAWK ST TUALATIN OR 970628121 96472952 false X N/A X 1957 OR SEE SCHEDULE O 10 0 5 0 0 0 0 0 79098497 81099673 31616 20622 0 0 79130113 81120295 0 0 77932297 81194347 0 0 0 0 0 1482219 1172204 79414516 82366551 -284403 -1246256 20822874 20346257 18414923 19060172 2407951 1286085 X SEE SCHEDULE O false false see schedule o 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 false false false false true 674 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 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 ken spray 1.0 X 0 0 0 STEPHEN ERDMANN 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 ASSOCIATED THIRD PARTY ADMINISTRATO 7600 SW MOHAWK ST TUALATIN OR 97062 CONTRACT ADMIN. 943070 REGENCE BLUECROSS BLUESHIELD of ore PO BOX 1271 M/S ELLA PORTLAND OR 97207 PPO PROVIDER ADMIN. 4951454 EXPRESS SCRIPTS PO BOX 390873 BLOOMINGTON MN 55439 CLAIMS COST CONTROL 488970 3 0 EMPLOYER CONTRIBUTIONS 900099 75495614 75495614 PARTICIPANT CONTRIBUTIONS 900099 5604059 5604059 81099673 114343 114343 0 0 15258936 15352657 -93721 -93721 -93721 0 0 0 0 81120295 81099673 20622 0 0 0 81194347 0 0 0 0 0 0 615895 54704 38375 0 0 12132 163146 0 230372 0 0 0 0 0 22243 0 0 0 35337 82366551 9175022 7614702 0 0 0 0 7968031 7952953 0 0 0 0 0 0 0 0 31761 35347 0 3648060 4743255 0 0 0 0 0 0 0 0 20822874 20346257 15736 64983 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18399187 18995189 18414923 19060172 X 0 0 0 0 2407951 1286085 2407951 1286085 20822874 20346257 X -1246256 124390 X false true true X 0 CLAIMS INCURRED BUT NOT REPORTED 6865000 ACCUMULATED ELIGIBILITY CREDITS 12130189 18995189 81120295 82366551 -1246256 124390 596002 720392 -525864 81244685 124390 124390 81120295 81120295 81770549 81770549 596002 596002 82366551 part xi, line 8 and part xiii, line 4b: ADJUSTMENTS FOR BENEFITS PAID FROM ACCRUAL BASIS (FORM 990) TO CASH basis (FINANCIAL STATEMENTS) = $596,002. 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 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 XI, LINE 5: UNREALIZED GAIN = $124,390.