2018-04-17T11:45:19-05:00 2017-05-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2016-06-01 204570305 LONG TERM CARE WORKERS HEALTH TRUST FUND HEALTH TRUST FUND LONG 8776985829 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 DAVID WERLIN TRUSTEE 8776985829 2018-04-17 1 SCOTT E HALLBERG CPA P01081188 2023319880 38.100.43.98 2018-04-17 12:43:36 ED P 0B5FA0604EC921149BCA0C9F7FF0732235262084 F9732D26F1862369112473F02FBFB10AC939BB18 2016 2021-01-29 14:40:06Z DAVID WERLIN 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 7437676 0 X N/A X 2006 CA THE TRUST WAS ESTABLISHED TO MAINTAIN THE LONG TERM CARE WORKERS HEALTH PLAN. THE PLAN WAS CREATED FOR THE EXCLUSIVE BENEFIT OF ELIGIBLE LONG TERM CARE WORKERS. THE PLAN PROVIDES HEALTH BENEFITS (MEDICAL, DENTAL, AND VISION) TO PARTICIPATING EMPLOYEES IN THE IN-HOME SUPPORTIVE SERVICES INDUSTRY OF CALIFORNIA, WHOSE EMPLOYERS ARE REQUIRED, BY CONTRACT, TO PAY CONTRIBUTIONS TO THE TRUST. 4 1 0 0 0 0 0 0 4763391 7277958 108482 135530 3795 24188 4875668 7437676 0 0 4759370 6682965 0 0 0 0 0 419180 538160 5178550 7221125 -302882 216551 9175619 9480313 13372 13573 9162247 9466740 SEE SCHEDULE O FOR DETAILS. 0 0 THE PLAN PROVIDES HEALTH BENEFITS SUCH AS MEDICAL, DENTAL, AND VISION TO PARTICIPATING EMPLOYEES IN THE IN-HOME SUPPORTIVE SERVICES INDUSTRY OF CALIFORNIA. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 X 4 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 CA X DELTA FUND ADMINISTRATORS LLC 2099405100 1234 WEST OAK STREET STOCKTON CA 95203 COOK SAMUEL FORMER CHAIR 1.00 40.00 X 0 121299 38582 CSEKEY TOM TRUSTEE 1.00 40.00 X 0 102321 0 BUTLER LAPHONZA TRUSTEE 1.00 40.00 X 0 220804 39000 WERLIN DAVID CHAIR 1.00 40.00 X 0 112105 0 MUNDY ROSA TRSUTEE 1.00 0.00 X 0 0 0 0 556529 77582 0 0 1 0 SCHWARTZ STEINSAPIR DOHRMANN & SOMMERS 6300 WILSHIRE BOULEVARD STE 2000 LOS ANGELES CA 90048 LEGAL SERVICES 106873 1 EMPLOYEE CONTRIBUTIONS 900099 6543413 6543413 EMPLOYER CONTRIBUTIONS 900099 734545 734545 7277958 135530 135530 MISCELLANOUS INCOME 900099 24188 24188 24188 7437676 7302146 0 135530 6682965 106873 24500 30158 2355 3620 18683 OUTREACH PROGRAM 272810 ADMINISTRATOR FEES 78323 OTHER EXPENSES 838 7221125 490335 281395 128248 133561 3360 4169 8165606 8387722 388070 673466 9175619 9480313 13372 13573 13372 13573 X 9162247 9466740 9162247 9466740 9175619 9480313 216551 87942 0 X 0 1 X 0 0 0 DUE FROM SEIU LOCAL 2015 673466 673466 X 7525618 87942 87942 7437676 0 7437676 7221125 0 7221125 0 7221125 PART X, LINE 2: THE PLAN IS INTENDED TO QUALIFY UNDER SECTION 501(C) (9) OF THE INTERNAL REVENUE CODE AND,THEREFORE, IS NOT SUBJECT TO INCOME TAX. THE PLAN OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE ON JANUARY 4, 2008, STATING THAT THE PLAN, AS THEN DESIGNED,WAS IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THE PLAN HAS ALSO RECEIVED A FAVORABLE TAX DETERMINATION LETTER FROM THE STATE OF CALIFORNIA. THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTERS. THE PLAN SPONSOR BELIEVES THAT THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION FOR FEDERAL OR CALIFORNIA INCOME TAXES HAS BEEN INCLUDED IN THE PLANS FINANCIAL STATEMENTS. AS OF MAY 31, 2017, THE STATUTE OF LIMITATIONS FOR TAX YEARS 2013 THROUGH 2015 REMAINS OPEN WITH THE U. S. FEDERAL JURISDICTION AND THE VARIOUS STATES AND LOCAL JURISDICTIONS IN WHICH THE PLAN FILES RETURNS. 0 0 0 COOK SAMUEL FORMER CHAIR 0 102981 0 4119 0 14199 0 20596 0 17986 0 159881 0 0 BUTLER LAPHONZA TRUSTEE 0 195000 0 7500 0 18304 0 39000 0 0 0 259804 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEE REVIEWS THE FORM 990 BEFORE FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C INTERNAL PROCEDURES INCLUDE THE CONTINUOUS REVIEW OF PROCEDURES TO ENSURE COMPLIANCE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ANY OF ITS DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC. SEIU LOCAL 2015 2910 BEVERLY BLVD LOS ANGELES CA 90057 474164197 UNITE MEMBERS INTO ONE ORG. FOR THE PURPOSE OF IMPROVING WORKING CONDITIONS CA 501(C)(5) 0 COUNTY OF SAN BENITO - STATE OF CALIFORNIA COUNTY OF SANTA CRUZ - STATE OF CALIFORNIA SEIU UNITED LONG-TERM CARE WORKERS LOCAL UNION NO 6434 2910 BEVERLY BLVD LOS ANGELES CA 90057 260718017 UNITE MEMBERS INTO ONE ORG. FOR THE PURPOSE OF IMPROVING WORKING CONDITIONS CA 501(C)(5) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1