2011-10-28T16:17:13-05:00 2010-12-31 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2010-01-01 936021475 OREGON TEAMSTER EMPLOYERS TRUST OREG 5032825581 PO BOX 4148 PORTLAND OR 972084148 STEPHEN S ERDMANN 5032825581 2011-10-28 1 9252779100 2010 2016-03-07 17:11:31Z STEPHEN S ERDMANN PO BOX 4148 PORTLAND OR 972084148 214882616 0 X N/A X 1957 OR TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 12 12 0 0 0 0 0 0 144527918 152733286 895124 1173947 1108737 24061 146531779 153931294 0 0 134147456 142265468 0 0 0 0 0 8300101 8142183 142447557 150407651 4084222 3523643 48172260 53537615 25358645 26859169 22813615 26678446 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 1 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 0 0 1 5 0 1 0 0 0 0 0 0 0 X 12 12 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 PO BOX 4148 PORTLAND OR 97208 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 JIM WELLS 0.00 X 0 0 0 JIM DRAPER 0.00 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 6572446 WILLIAM C EARHART CO INC 3140 NE BROADWAY ST PORTLAND OR 97232 THIRD PARTY ADMINISTRATIVE FEES 719626 SCRIBNER SCRIBNER & SUTTON 1523 NE 6TH AVENUE PORTLAND OR 97232 PAYROLL AUDITS 138579 VISION SERVICE PLAN 3333 QUALITY DRIVE RANCHO CORDOVA CA 95670 CLAIMS ADMINISTRATION 125541 MILLIMAN INC 650 CALIFORNIA STREET 17TH FLOOR SAN FRANCISCO CA 94108 CONSULTING SERVICES 121536 5 EMPLOYER CONTRIBUTIONS 900099 139899928 139899928 PARTICIPANT CONTRIBUTI 900099 7846503 7846503 PRESCRIPTION REBATES 900099 2181741 2181741 MEDICARE PART D SUBSID 900099 647237 647237 ERRP INCOME 900099 625681 625681 1532196 1532196 152733286 978970 978970 61146299 60951322 194977 194977 194977 CLASS ACTION SETTLEMEN 900099 20464 20464 OTHER INCOME 900099 3597 3597 24061 153931294 152733286 0 1198008 142265468 717821 131395 171645 76962 6842158 85984 41166 75052 150407651 760129 6685388 13480532 15359837 33931599 31492390 48172260 53537615 715014 699840 579122 567997 24064509 25591332 25358645 26859169 X 0 0 0 0 22813615 26678446 22813615 26678446 48172260 53537615 X 3523643 341188 X X 0 1 1 X 0 0 CLAIMS PAYABLE AND IBNR 12485400 PREMIUMS PAYABLE 1109932 ACCUMULATED ELIGIBILITY CREDITS 11996000 25591332 153931294 150407651 3523643 341188 1526823 1868011 5391654 154195520 341188 341188 153854332 76962 76962 153931294 148803866 0 148803866 76962 1526823 1603785 150407651 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 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 RECLUSE 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. FORM 990, PART XI, LINE 5, CHANGE IN NET ASSETS NET UNREALIZED GAINS ON INVESTMENTS: $341,188