2019-11-12T16:43:32-06:00 2018-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2018-01-01 412261950 DISTRICT COUNCIL 16 OF NORTHERN CALIFORNIA HEALTH & WELFARE TRUST DIST 8009229902 4160 DUBLIN BLVD NO 400 DUBLIN CA 945687723 CHRIS CHRISTOPHERSEN TRUSTEE 8009229902 2019-11-12 1 JOSEPH M THIERMANN P01066616 9252779100 66.7.226.66 2019-11-12 14:42:50 PS P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2018 2020-03-31 21:24:44Z CHRIS CHRISTOPHERSEN 4160 DUBLIN BLVD NO 400 DUBLIN CA 945687723 142696443 0 X HTTP://WWW.DC16TRUSTFUND.ORG X 2008 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 9 0 108 0 0 0 0 0 132435747 138392052 2712118 3452089 142573 0 135290438 141844141 0 0 108217124 118338352 0 0 0 0 0 4432310 4273803 112649434 122612155 22641004 19231986 155819922 170974202 60416891 61559826 95403031 109414376 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 4 0 1 108 1 0 0 0 0 0 0 0 0 X 9 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 8009229902 4160 DUBLIN BOULEVARD SUITE 400 DUBLIN CA 945687756 X STEVE CASTER TRUSTEE 1.00 X 0 0 0 JOHN SHERAK TRUSTEE 1.00 X 0 0 0 JOHN MAGGIORE TRUSTEE 1.00 X 0 0 0 MARIAN BOURBOULIS TRUSTEE - PAST 1.00 X 0 0 0 CHRIS CHRISTOPHERSEN TRUSTEE 1.00 X 0 0 0 DARYL STACY TRUSTEE 1.00 X 0 0 0 ROBERT WILLIAMS ALT. TRUSTEE 1.00 X 0 0 0 SAL MADRIGAL TRUSTEE 1.00 X 0 0 0 STEVE ECKSTROM TRUSTEE 1.00 X 0 0 0 FRANK NUNES ALT. TRUSTEE 1.00 X 0 0 0 JEANNIE SIMPELO ALT. TRUSTEE 1.00 X 0 0 0 TIM DEAL TRUSTEE 1.00 X 0 0 0 JOSE SANTANA ALT. TRUSTEE - PAST 1.00 X 0 0 0 JAMES HEWETT TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 1.00 X 0 1 0 0 1 0 0 0 0 0 HEALTH SERVICES AND BENEFIT ADMINISTRATO 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 FUND ADMINISTRATION 1843918 ANTHEM BLUE CROSS 700 BROADWAY DENVER CO 80273 COST CONTAINMENT 578294 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 BENEFITS ADMINISTRATOR 418204 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDITOR 402267 SALTZMAN AND JOHNSON 44 MONTGOMERY STREET SUITE 2110 SAN FRANCISCO CA 94104 ATTORNEY 260731 10 EMPLOYER CONTRIBUTIONS 900099 127787658 127787658 PARTICIPANT CONTRIBUTIONS 900099 7770023 7770023 STOP LOSS REIMBURSEMENT 900099 2130197 2130197 LIQUIDATED DAMGES 900099 345524 345524 PRESCRIPTION REBATES 900099 339337 339337 19313 19313 138392052 2615514 2615514 1688877 852302 836575 836575 836575 141844141 138392052 0 3452089 118338352 1707889 260731 402267 109561 1508434 224361 11154 49406 122612155 35820154 29379690 9179570 12068050 14263282 15181888 7033 6997 96306737 114101613 243146 235964 155819922 170974202 450519 341083 462452 454670 59503920 60764073 60416891 61559826 X 0 0 0 0 95403031 109414376 95403031 109414376 155819922 170974202 19231986 -5220641 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 19295456 BENEFIT CLAIMS PAYABLE & IBNR 7311339 EMPLOYER BOND DEPOSITS 79114 CASH BANK LIABILITY 32079185 DUE TO BROKER FOR SECURITIES PURCHASE 1998979 60764073 X 136513940 -5220640 -5220640 141734580 109561 109561 141844141 123241421 0 123241421 109561 -738827 -629266 122612155 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, 2018, 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 FISCAL YEARS PRIOR TO 2015. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS DELEGATED CERTAIN MANAGEMENT DUTIES TO A THIRD-PARTY ADMINISTRATOR UNDER THE SUPERVISION OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES IS SUBJECT TO THE FIDUCIARY RESPONSIBILITY PROVISIONS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA), AS AMENDED, INCLUDING THE CONFLICT-OF-INTEREST PROVISIONS OF ERISA SECTION 406. ANNUALLY AT THE BOARD OF TRUSTEES MEETING, THE TRUSTEES ARE REQUIRED TO DISCLOSE IF THERE ARE ANY CONFLICTS OF INTEREST. 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 STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFMORMATION, PLEASE CONTACT THE ADMINISTRATOR. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. DISTRICT COUNCIL NO 16 2705 CONSTITUTION DRIVE LIVERMORE CA 945509206 940433056 EMPLOYEE SPONSORING ORGANIZATION CA 501(C)5 N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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, 2018, THERE ARE APPROXIMATELY 533 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, 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 IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. A & A PAINTING COMPANY A & B PAINTING INC A & S FLOORING A AMERICAN CUSTOM FLOORING INC. ABCO RESTORATION & WATERPROOFING INC ACR GLASS AND DOORS ADERHOLT SPEC CO INC ADVANCED INDUSTRIAL SERVICES INC. ADVANTAGE COMMERCIAL SURFACES AHC GLASS CO(SAFECO) AJS PAINTING AKIMA CONSTRUCTION SERVICES LLC ALAN GARTHWAITE INDUSTRIES ALCAL GLASS SYSTEMS INC. ALCOSTA SHOWER DOOR ALII FLOORING INC ALL BAY AREA GLASS INC. ALL COUNTY FLOORING ALL FLOORING ALL NEW GLASS OF CALIFORNIA ALLIANCE GLASS COMPANY ALLIED FLOOR CORPORATION ALLIED PAINTERS INC ALPHA GLASS COMPANY AMAX GLASS & GLAZING INC. AMERICAN GLASS AMG CONSTRUCTION ANDRE'S GLASS SERVICE ANEMOS ENTERPRISES INC. ANNING & JOHNSON COMPANY APPLIED FINISHES APPLY A LINE INC APPRENTICE CMTE ARAGON CONSTRUCTION INC. ARCHITECTURAL GLASS & ALUMINUM ARROW GLASS CO ARTIFICIAL GRASS PROS ARTISTIC DRYWALL SYSTEMS ATLAS GLASS CO. INC. B & C PAINTING & DECORATING B & G GLASS INC. B J FLOORING INC B&C/JERRY THOMPSON & SONS PTG AJV B.T. MANCINI CO. INC. 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KYA SERVICES LLC KYO-YA HOTELS & RESORTS LP LANCE'S CARPET COMPANY INC LANE'S CARPET INSTALLATION LLC LARRY SILVESTRI INC LEDEIT & SONS GLASS INC LEI FLOOR AND WINDOW CVRNGS LEVEL 5 INC. LIBERTY MAINTENANCE INC. LINCOLN GLASS & MIRROR CO LINEATION MARKINGS CORP LINOLEUM CARPET TILE & PLASTIC LINOLEUM LARRY'S INC. LINOLEUM SALES CO INC LINOLEUM SALES CO. INC LISA DE LA SOL RESTORATION LOMA LINDA INTERIORS LUCAS PAINTING CO. M & J FLOORCOVERING INC. M & R PAINTING M S F INC M.W.I. INC MADDEN AND NELSON INC MADSEN BUILDERS MAGNUM DRYWALL INC MAJESTIC CONSTRUCTION MAJESTIC FLOORS INC. MAR CON COMPANY MASON PAINTING INC MASSIMO RODORIGO DBA NORTH SIDE MASTER PAINTING & DECORATING MASTERPIECE PAINTING MASTRIA INCORPORATED MIKE QUINTON INSTALLATIONS INC MIKES CUSTOM FLOORING INC. MILE HIGH FLOORING MISSION BAY FLOORING CONTRACTORS MISSION GLASS CO MIURA BUILDING ENCLOSURES MK EMMY MODERN FLOORING LLC MOLINA'S PTG WALLCOVERING MONTICELLI PTG & DEC INC MOORE FLOORING INC. 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