2022-09-25T16:21:07-05:00 2021-12-31 222027092 WITHUMSMITHBROWN PC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2021-01-01 946078226 AUTOMOTIVE INDUSTRIES WELFARE FUND AUTO 8006353105 4160 DUBLIN BOULEVARD 400 DUBLIN CA 945687756 TOM DILLON CO - CHAIR 8006353105 2022-09-25 1 TOM DILLON 999009999 JESSICA R ROSTER P01317380 9252779100 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z TOM DILLON 4160 DUBLIN BOULEVARD 400 DUBLIN CA 945687756 89852194 0 X N/A X 1956 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 0 147 0 0 0 0 0 54482144 53137575 1415263 1404850 0 0 55897407 54542425 0 0 46323127 49755242 140396 142431 0 0 0 2291075 2384081 48754598 52281754 7142809 2260671 49462087 55942659 2717774 6403128 46744313 49539531 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER COLLECTIVE BARGAINING AGREEMENTS. 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 38 0 1 147 1 0 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICES & BENEFITS ADMINISTRATORS INC 8006353105 4160 DUBLIN BOULEVARD 400 DUBLIN CA 945687756 CHARLES BESOCKE FUND MANAGER 40.00 X 182769 0 48767 DON CROSATTO TRUSTEE 1.00 X 0 0 0 STEPHEN MACK TRUSTEE 1.00 X 0 0 0 JOHN DIBERNARDO TRUSTEE 1.00 X 0 0 0 RICH MORALES TRUSTEE 1.00 X 0 0 0 JIM BENO CO-CHAIR 2.00 X 0 0 0 TOM DILLON CO-CHAIR 2.00 X 0 0 0 STEVE SOWINSKI TRUSTEE 1.00 X 0 0 0 JIM SCHWANTZ TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 1 0 182769 1 48767 1 0 1 0 HEALTH SERVICES & BENEFIT ADMINISTRATORS 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 ADMINISTRATION 1169081 LINDQUIST LLP 5000 EXECUTIVE PKWY SUITE 400 SAN RAMON CA 94583 AUDIT 349923 ANTHEM BLUE CROSS 11050 OLSON DR SUITE 110 RANCHO CORDOVA CA 95670 CLAIMS PROCESSING 211016 DELTA DENTAL OF CALIFORNIA 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS PROCESSING 157171 THE SEGAL COMPANY 120 MONTGOMERY ST SAN FRANCISCO CA 94104 CONSULTING 130815 5 EMPLOYER CONTRIBUTIONS 900099 51233442 51233442 STOP LOSS REIMBURSMENT 900099 1276644 1276644 PRESCRIPTION REBATES 900099 403545 403545 PARTICIPANT CONTRIBUTIONS 900099 214336 214336 LIQUIDATED DAMAGES 900099 9608 9608 53137575 773121 773121 35941498 35309769 631729 631729 631729 54542425 53137575 0 1404850 49755242 105914 15667 14093 6757 1100828 38638 349922 74036 572441 163058 3950 81208 52281754 17132153 8806028 60529 940518 32639 32171 32236766 46163942 49462087 55942659 590045 1730678 2127729 4672450 2717774 6403128 X 0 0 0 0 46744313 49539531 46744313 49539531 49462087 55942659 2260671 534547 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 190000 BENEFIT CLAIMS PAYABLE AND IBNR 4482450 4672450 X 55002936 534547 534547 54468389 74036 74036 54542425 49681746 0 49681746 74036 2525972 2600008 52281754 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2021, 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'S ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2018. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 2,525,972. X 0 0 0 CHARLES BESOCKE FUND MANAGER 182769 0 0 0 0 0 24167 0 24600 0 231536 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH HEALTH SERVICES AND BENEFIT ADMINISTRATORS TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY WHO REVIEW THE RETURN PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE, OFFICER AND MANAGEMENT EMPLOYEE WITH DELEGATED POWERS WHO CAN INFLUENCE THE ACTIONS OF AUTOMOTIVE INDUSTRIES WELFARE FUND IS COVERED UNDER THE CONFLICT-OF-INTEREST POLICY. IF A CONFLICTING INTEREST EXISTS, THE PERSON WITH THE CONFLICT IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL INFORMATION AVAILABLE TO THE PUBLIC AND THE ORGANIZATION'S MEMBERS UPON REQUEST. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THERE HAS BEEN NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR. FORM 990, PART XI, LINE 7: THE REPORTABLE COMPENSATION REPORTED ON PART VII FOR CHARLES BESOCKE INCLUDES TOTAL COMPENSATION OF $182,769 FOR SERVICES PROVIDED TO VARIOUS AUTOMOTIVE INDUSTRIES TRUST FUNDS, INCLUDING AUTOMOTIVE INDUSTRIES WELFARE FUND. THE COMPENSATION ALLOCATED TO THE AUTOMOTIVE INDUSTRIES WELFARE FUND OF $105,914 IS REPORTED ON PART IX STATEMENT OF FUNCTIONAL EXPENSES. AUTOMOTIVE INDUSTRIES PENSION PLAN 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 945687756 941133245 TO PROVIDE PENSION BENEFITS CA 501(A) N/A N/A 0 CMTA-IAM JOINT RETIREE HEALTH & WELFARE TRUST 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 945687756 946130509 TO PROVIDE HEALTH BENEFITS CA 501(C)(9) N/A N/A 0 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 DECEMBER 31, 2021, THERE ARE APPROXIMATELY 200 EMPLOYERS AND VARIOUS SPONSORING ORGANIZATIONS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS AND VARIOUS SPONSORING ORGANIZATIONS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER AND VARIOUS SPONSORING ORGANIZATION IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS AND VARIOUS SPONSORING ORGANIZATIONS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. KOEHLER AUTO BODY WORKS NELSON BODY SHOP SAN JOSE DIE CASTING & MACH ACE TRUCK REPAIR ALAMEDA COUNTY INDUSTRIES AKIMA LOGISTICS SERVICES LL ALBANY FORD SUBARU ALLISON BMW AMPORTS ANTIOCH AUTO CENTER ARAMARK UNIFORM SERVICES, I AUDI OF STEVENS CREEK AUTO WEST HONDA AUTOMOTIVE APPRENTICE TRUST BABBITT BEARING COMPANY BAY LINE CONCRETE CUTTING & BENNER AUTO REPAIR, INC. BERKELEY HONDA AUTO CENTER BILL BRANDT FORD REPUBLIC SERVICES C H BULL CO CAIETTIS TRUCK REPAIR CAL BODY STEEL FORMING LEHIGH SOUTHWEST CEMENT CO CALIFORNIA TANK LINES, INC CALIFORNIA WASTE SOLUTIONS CAPITAL MACHINE CORPORATION AB CAR RENTAL SERVICES, INC CENTRAL CONCRETE SUPPLY CO, CENTRAL CONTRA COSTA TRANSI CHUCK'S BRAKE AND WHEEL CLUTCH & BRAKE XCHANGE, INC COAST COUNTIES TRUCK & EQUI COCA COLA BOTTLING CO COLE EUROPEAN, INC. COMMERCIAL SPEEDOMETER SERV COMMERCIAL TRUCK CO CONCORD TOYOTA CON GLOBAL INDUSTRIES (CGI) EAST BAY CLARKLIFT - LOCAL CUMMINS PACIFIC, LLC HENRY CURTIS FORD DARLING INTERNATIONAL, INC. DIEGO TRUCK REPAIR, INC. AFSCME DISTRICT COUNCIL #57 IAM & AW LOCAL LODGE 93 I A OF M LODGE 190 MJDAY PE RODNEY DUTRA SERVICE I A OF M LODGE 1546 EARTHGRAINS EAST BAY CLARKLIFT LIBERTY FLEET CARE EURO-AM AUTO SERVICE MERITOR INC FLEXI-VAN LEASING INC FRANCISCAN MOTORS DBA ACURA FRED'S BODY SHOP, INC. FRESNO TRUCK CENTER FRITZ & PETERS G & H DIESEL SERVICE, INC. G & M AUTOBODY, INC. GEIGER MFG, INC GENUINE MOTORS LLC GILLIG CORPORATION GOLDEN GATE TRANSIT GOLDEN GATE TRUCK CENTER JOE GOMES TRUCKING, INC. GRANITE ROCK CO #17072 HALLOWELL CHEVROLET HAYWARD FORD,INC HEDRICK'S COLLISION CENTER HERTZ CORPORATION HONDA OF EL CERRITO HONDA OF STEVENS CREEK HUBBARD MACHINE SHOP I A OF M LOCAL 653 I A OF M LOCAL 1173 INDUSTRIAL MACHINE SHOP RUAN TRANSPORT CORP FIRST STUDENT INC LEE'S FORKLIFT SERVICE LIVERMORE SANITATION, INC. LOOMIS I A OF M LODGE 190 I A OF M LODGE 725 MAGNUSSEN TOYOTA OF PALO AL MAITA OLDSMOBILE MARINE TERMINALS CORP MARTINEZ AUTO BODY SHOP SSA TERMINALS GEORGE MC GILLS BODY SHOP H W MC KEVITT CO INC HWM AUTO CORP GLENCORE RECYCLING INC MILL VALLEY REFUSE SERVICE, NOEL MILLER INC MOORE BUICK CORP BOB MOTTERS BODY SHOP, INC. NATIONAL CAR RENTAL / VANGU MV TRANSPORTATION INC NATIONAL AEROSPACE SOLUTION D W NICHOLSON CORP NORMANDIN CHRYSLER PLY NOVATO AUTO CENTER PAR 3 MOTORS INC PACIFIC AUTO REPAIR INC PALM AVENUE MOTORS RALPH PANELLA LEASING PARKER ROBB CHEVROLET PBA MAINTENANCE PENINSULA AUTO MACHINISTS # PENINSULA FORD OF SUNNYVALE PIERCEY TOYOTA - PENSKE NOR PENSKE TRUCK LEASING PETALUMA ACQUISITIONS, LLC PETER PAN MOTORS PETKARRIS, INC PLEASANTON TRUCK & EQUIPMEN PRECISION STRIPPING & COATI CEMEX RAIL TERMINAL SERVICES RECTOR MOTOR CAR SAFEWAY STORES INC. REPUBLIC SERVICES-RICHMOND RIVERVIEW INTERNATIONAL TRU RYDER TRUCK RENTAL INC SFO SHUTTLE BUS CO ST FRANCIS ELECTRIC SAN FRANCISCO HONDA I A OF M LOCAL 1101 SAN LEANDRO AUTO SAN PABLO AUTOMOTIVE SUPPLY SANTA CLARA CO AUTO APPRENT SERRAMONTE FORD INC SHAMROCK MATERIALS INC SIERRA LOBO CORP SILGAN CONTAINER CORP-MODES SIMS RECYCLING SOLUTIONS L A SMITH & SONS SOSCOL AUTO BODY SOUTH BAY AFL-CIO LABOR COU SPECIALTY DISTRIBUTORS SPECIALTY TRUCK PARTS, INC STEVENS CREEK BMW STEVENS CREEK LEXUS STEVENS CREEK TOYOTA STEWART CHEVROLET JACOBS TECHNOLOGY, INC. SYAR INDUSTRIES INC. TEAMSTERS LOCAL 853 A TEICHERT & SON INC TOYOTA MATERIAL HANDLING TOYOTA OF VALLEJO UNITED PARCEL SERVICE VALLEY RESTORATION VIEIRA'S VALLEY EQUIPMENT C WALSH STATION AUTO SERVICE WASTE MANAGEMENT OF ALAMEDA WEST COUNTY RESOURCE RECOVE WORKING PARTNERSHIP USA YANG ENTERPRISES, INC. LEHMER'S WINTER CHEVROLET THERMA SERVICES LLC UNITED PARCEL SERVICE GREYHOUND LINES A & B DIE CASTING ASHLOCK CO ATLAS PACIFIC ENGINEERING C CARGILL SALT CORNELY CO DIAMOND MFG CORP DONAL MACHINE INC G-P CORPORATION, INC. HECO-PACIFIC MFG INC KNOPP INC GEORGE M MARTIN CO L P MCNEAR BRICK CO OAKLAND MACHINE WORKS PUMP REPAIR SERVICE CO SARDEE INDUSTRIES INC SILGAN CONTAINER CORP-RIVER VAN BEBBER BROS VERIFLO CORP WESTERN GRINDING SERVICE IN VINCENT WHITNEY WINTER CHEVROLET - SERVICE ZUM SF INC JOURNEYMAN ONLY PACIFIC WAREHOUSE COMPANY HUSKY TERMINAL & STEVEDORIN METROPOLITAN STEVEDORE COMP FALCK AB & I FOUNDRY FRONTIER FORD PACIFIC POWER GROUP CALIFORNIA WASTE SOLUTIONS( REPUBLIC SERVICES-W COSTA S AUTOMOTIVE INDUSTRIES TRUST JACOBS TECHNOLOGY INC CALIFORNIA CONFERENCE OF MA