2017-11-14T15:36:18-06:00 2016-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2016-01-01 412261950 DISTRICT COUNCIL 16 OF NORTHERN CALIFORNIA HEALTH & WELFARE TRUST DIST 8009229902 4160 DUBLIN BLVD NO 400 DUBLIN CA 945687723 CHRIS CHRISTOPHERSEN TRUSTEE 8009229902 2017-11-14 1 JOSEPH M THIERMANN P01066616 9252779100 66.7.226.66 2017-11-14 13:36:09 PS P 72DCDAB48BBD05C01ADC32EAF6F951C821B03640 6DD8E3D40C39F05221E97E07BD1CB8F36D910CAE 2016 2017-02-10 21:41:12Z X CHRIS CHRISTOPHERSEN 4160 DUBLIN BLVD NO 400 DUBLIN CA 945687723 124675337 0 X HTTP://WWW.DC16TRUSTFUND.ORG X 2008 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 9 0 106 0 0 0 0 0 110408825 122811763 1500236 1863574 1452 0 111910513 124675337 0 0 96563607 98481341 0 0 0 0 0 4466852 4854128 101030459 103335469 10880054 21339868 94044788 122524723 48766988 53553435 45277800 68971288 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 1 106 1 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 VINCE ECHEVERRIA ALT. TRUSTEE - PAST 1.00 X 0 0 0 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 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 THOMAS HEINZELMANN ALT. 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 MIKE WEST 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 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 1 0 0 1 0 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 FUND ADMINISTRATION 2065467 ANTHEM BLUE CROSS 700 BROADWAY DENVER CO 80273 COST CONTAINMENT 558561 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDITOR 487563 SALTZMAN AND JOHNSON 44 MONTGOMERY STREET SUITE 2110 SAN FRANCISCO CA 94104 ATTORNEY 406745 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 BENEFITS ADMINISTRATOR 365537 10 EMPLOYER CONTRIBUTIONS 900099 112083419 112083419 PARTICIPANT CONTRIBUTIONS 900099 8370258 8370258 STOP LOSS REIMBURSEMENT 900099 1383813 1383813 RETIREE DRUG SUBSIDY 900099 466799 466799 LIQUIDATED DAMGES 900099 287736 287736 219738 219738 122811763 1863574 1863574 124675337 122811763 0 1863574 98481341 2163739 406745 489322 75460 1509244 169325 1833 38460 103335469 14084015 23366628 10408365 8247242 10906501 12247990 25534 5768 58568585 78236108 51788 420987 94044788 122524723 676976 1123543 184181 0 47905831 52429892 48766988 53553435 X 0 0 0 0 45277800 68971288 45277800 68971288 94044788 122524723 21339868 2353620 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 14440622 BENEFIT CLAIMS PAYABLE & IBNR 9988000 EMPLOYER BOND DEPOSITS 79114 CASH BANK LIABILITY 27922156 52429892 X 126953497 2353620 2353620 124599877 75460 75460 124675337 98443738 0 98443738 75460 4816271 4891731 103335469 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, 2016, 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 2013. 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 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 DEPDENDENTS. AS OF DECEMBER 31, 2016, THERE ARE APPROXIMATELY 352 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. 1ST IMPRESSION CONSTRUCTION A & B PAINTING INC ABCO RESTORATION & WATERPROOFING ACR GLASS AND DOORS ADERHOLT SPEC CO INC AHC GLASS CO(SAFECO) AJS PAINTING AKIMA CONSTRUCTION SERVICES LL ALAMEDA COUNTY BLD & TRADES CO ALCAL ARCADE CONTRACTING, INC. ALCOSTA SHOWER DOOR ALL BAY AREA GLASS, INC. ALL COUNTY FLOORING ALLIANCE GLASS COMPANY ALLIED PAINTERS INC ANDERSON CARPET & LINOLEUM SAL ANDRE'S GLASS SERVICE ANNING & JOHNSON COMPANY APPLY A LINE INC ARAGON CONSTRUCTION, INC. ARCHITECTURAL GLASS & ALUMINUM ARROW GLASS CO ATLAS GLASS CO. INC. B & C PAINTING & DECORATING B & G GLASS, INC. B J FLOORING INC B.T. MANCINI COMPANY BACA & SONS PAINTING BAGATELOS ARCH GLASS SYSTEMS BASCO DRYWALL & PAINTING CO. BAY CITIES PTRS & DEC BAYSIDE INTERIORS INC BELIVEAU ENGINEERING CONTR INC BELL PAINTING BENASSI'S CARPET SERVICE BENSON INDUSTRIES, LLC BEST CONTRACTING SERVICES, INC BLUE SKIES PAINTING BOYETT CONSTRUCTION INC BRADY COMPANY/CENTRAL CA INC. BRAND ENERGY SVC OF CA INC BRITE PAINTING BRUCE K HALL CONSTRUCTION INC C & J PAINTING C & O PAINTING INC C & S FLOOR SYSTEMS, INC. C & W FACILITY SERVICES, INC. C A BUCHER PTG SERVICE C-3 CONCRETE SURFACE INC. C/S ERECTORS INC CAL INC. CAL TILE COMPANY INC. CALIFORNIA CUSTOM TINTING CALIFORNIA DRYWALL COMPANY CALIFORNIA ENGINEERING CAPITOL GLASS COMPANY CARPET DIMENSION, INC. CDCR REGIONAL ACCTING OFFICE CEE GEE PKG LOT STRIPING CENTERLINE STRIPING CENTRAL STRIPING SERVICE INC CENTURY CARPET CERTIFIED COATING OF CALIFORNI CHRISP COMPANY CITY PAINTING CO CL COATINGS, INC. CLASSIC GLASS INC CLIFT HOTEL CLINE GLASS CONTRACTORS, INC. CNJ ENTERPRISES, INC. COAST COUNTIES GLASS COFFEY BUILDING GROUP INC. COMMERCIAL GLASS & ALUM INC COMPONENT WEST, INC. CONCORD DRYWALL, INC CONKLIN BROS S F CONKLIN BROS-SANTA ROSA COOL PAINTING COR-RAY PAINTING COX COMMERCIAL FLOORING INC CREATIVE CEILINGS, INC. CREATIVE FLOOR COVERINGS CREATIVE SHOWER DOOR CROWN CORR, INC. CROWN SKYLIGHTS INC CUSTOM DRYWALL INC CYC COMMERCIAL INTERIORS, INC. SCHEDULE R. IDENTIFICATION OF RELATED ORGANIZATIONS (CONT'D) D & B PAINTING COMPANY D & C GLASS D & R GLASS, INC. D C VIENT INC D P R CONSTRUCTION, INC D ZELINSKY & SON INC D&B/JTS PAINTING INC. JV D.S. BAXLEY, INC. DBA DSB+ EAS DALEYS DRYWALL INC DARDEN PAINTING INC DASCO CONSTRUCTION & DR DDPD INC DELTA CITY DRYWALL INC DENHAM CONTRACTING INC DEPT OF GENERAL SERVICES DIETLIN PNTG & DEC DISTRICT COUNCIL 16 DISTRICT COUNCIL 16 (HAYWARD) DIVERSIFIED FLOORING SERV DONALD E. MCNABB CO. DOTTO GLASS INC DOWNEY AND SON DUGGAN & ASSOCIATES, INC. DYNAMIC COATINGS, INC. EAST BAY GLASS COMPANY INC. ECO BAY SERVICES, INC. ELADIO R GUTIERREZ ELITE PAINTING & WALLCOVERING, ELLIS FLOORING INC ENCLOS CORP/ HARMON ERIC STARK INTERIORS EVAN PATTERSON CONSTRUCTION EVERGREENE PAINTING STUDIO EVERLAST BUILDERS INC. EXCLUSIVELY DOORS EXPERT DRYWALL SYS INC EXTERIOR CLADDING SYSTEMS, INC F D THOMAS INC FAIRMONT HOTEL SAN JOSE FDR DRYWALL, INC. FEDOR WALL SYSTEMS, INC. FIELDTURF USA INC FLOOR COVERING ASSOCIATION/ FLOOR SEAL TECH ATTN:LETICIA FLORES DRYWALL INC. FORTSON FLOORS, INC. FRANCISCAN GLASS CO INC FREEMAN CONSTRUCTION COMPANY FREY PLASTERING INC FUENTES PAINTING & DECORATING G & B PAINTING GAIDANO & SONS PTG & DECORATIN GENESIS FLOORING INC. GEORGE E MASKER INC GIAMPOLINI & COMPANY GIROUX GLASS, INC. GLASS & SASH CO GLASS CONCEPTS BY CLINE GOLDEN GATE DRYWALL GOLDEN GATE GLASS & MIRROR CO GOLDEN STATE CARPET SERVC GRAND HYATT GRAND PRIX GLASS GREATER BAY FLOORING INC GUGEL/TODAY PTG & DEC INC H.V. WELKER CO., INC. HALSTEAD DRYWALL INC HANSAN FLOORING HARDMAN GLAZING HAROLD W. THOMPSON HARRISON DRYWALL, INC HARRY L MURPHY HASSON PAINTING CONTRACTORS IN HERLACHE & SONS PAINTING HERRON PAINTING COMPANY HOEM & ASSOCIATES, INC. HYATT REGENCY INSULATION ACOUSTIC DRYWALL INTERIOR GLASS SYSTEM IRONWOOD COMMERCIAL BLDRS INC J & J ACOUSTICS INC J & R THOMPSON, INC JAMES L. HARRIS PAINTING INC JANGHO CURTAIN WALL AMERICAS C JEFFCO PAINTING & COATING, INC JERRY THOMPSON & SONS INC JIMENEZ PAINTING DBA US NATION JMW CARPET & FLOORING INC. JOHN JORY CORPORATION JR CONSTRUCTION KAISER FOUNDATION HOSP CPFC KARSYN CONSTRUCTION INC KBI PAINTING, INC. KEENAN HOPKINS AND SUDER KIM'S FLOORING, INC KIRK BUILDERS KLW CONSTRUCTION INC. KYO-YA HOTELS & RESORTS, LP LARRY SILVESTRI INC LEDEIT & SONS GLASS INC LEVEL 5, INC. LIBERTY MAINTENANCE, INC. LINCOLN GLASS & MIRROR CO LINEAR OPTIONS LINOLEUM LARRY'S INC. LINOLEUM SALES COMPANY LUCAS PAINTING CO. SCHEDULE R. IDENTIFICATION OF RELATED ORGANIZATIONS (CONT'D) M & R PAINTING M S F INC MADDEN AND NELSON INC MADSEN BUILDERS MAGNUM DRYWALL INC MAJESTIC CONSTRUCTION MAJESTIC FLOORS, INC. MAR CON COMPANY MASON PAINTING INC MASTERPIECE PAINTING MASTRIA INCORPORATED METRO SERVICE GROUP MGM DRYWALL INC MISSION BAY FLOORING CONTRACTO MISSION GLASS CO MOLINA'S PTG WALLCOVERING MOMENTUM MANAGEMENT INC. MONTICELLI PTG & DEC INC MUEHLHAN CERTIFIED COATINGS MURPHY INDUSTRIAL COATINGS NAHIDI CORPORATION DBA KAISER NATIONAL COATING & LINING COMP NC FLOORING GROUP INC NELSONS PAINTING NEVELL GROUP INC. NEW WEST PARTITIONS NOR-CAL GLASS NORTH COUNTIES DRYWALL INC NORTHERN PACIFIC DRYWALL INC NU-GLASS SYSTEM OAKLAND HILTON HOTEL OAKLAND HOUSING AUTHORITY ONEILL GLASS INC OREILLY & FAINA GLASS CO INC PACE INC PACIFIC GLAZING CONTRACTORS PACIFIC PERF ENT. INC. DRYWALL PACIFIC PERFORMANCE DRYWALL, I PACIFIC RACING ASSN PACIFIC SEALANTS PACIFIC SHORES CONSTRUCTION PAIGE STRUCTURAL GLASS PATRICK J RUANE INC PATRIOT CONTRACTING, INC. PERFORMANCE CONTRACTING GROUP PERFORMANCE WATERPROOFING PERMASTEELISA NORTH AMERICA CO PICONE PAINTERS PICTURE PAINTING & DECORATING, PINGUELO CONSTRUCTION PINNACLE INSTALLATIONS INC. PREMIUM GLASS PRO INS. DBA SPECTRA CONTRACT PRO INSTALLATION INC DBA PROSP PROGRESS GLASS PYRAMID PAINTING INC. QOL CORP. QUALITY GLASS CO R & I GLASSWORKS R & S GLAZING SPECIALTIES R J INC. R M R CONSTRUCTION R.E. CUDDIE CO. RAFAEL FLOOR COVERING INC RANKER AMG, INC RAYMOND-NORTHERN CALIFORNIA IN RECORD AUTOMATIC DOORS, INC. REDHAWK GLASS, INC. REDWOOD PAINTING CO INC RENO'S FLOOR COVERING REYES DRYWALL INC. RFJ INC. DBA MEISWINKEL CO RHODES PAINTING RICHLEN COMPANY RLM ENTERPRISES ROCKAWAY CONSTRUCTION INC ROMANO'S PAINTING & HANGING ROYAL GLASS CO INC ROYALTY PRO PAINTING RUDOLPH COMMERCIAL INTERIORS RUIZ PAINTING & WALLCOVERING RUSSELL HINTON COMPANY RUTHERFORD CO., INC. RYNOCLAD INC DBA RYNOCLAD TECH SCHEDULE R. IDENTIFICATION OF RELATED ORGANIZATIONS (CONT'D) S & R DRYWALL INC S D FLOORING, INC. S F HOUSING AUTHORITY SAFWAY SERVICES LLC SAMAP USA CORP SAN FRANCISCO HILTON & TOWERS SAN JOAQUIN GLASS SAN MATEO CITY BLDG TRADES SATELLITE PAINTING INC SDV SERVICES INC. SEELE INC. SIGNATURE GLASS & WINDOW SILICON VALLEY GLASS INC SIMPSON SANDBLASTING SKYLIGHT TECHNOLOGIES INC. SLATER CUSTOM PAINTING SLING - SHOT DRYWALL SME STEEL CONTRACTORS, INC. SMG SOUTHSIDE FLOORING SPACETONE ACOUSTICS, INC. SPECIALTY FLOORING, INC. ST FRANCIS SQUARE APTS INC STANDARD DRYWALL, INC. STANFORD COURT STAR GLASS CO STAR PROGRAM, INC. STAR WALLCOVERINGS STEWARD FLOOR COVERING STOCKHAM CONSTRUCTION STUART DEAN SUNSHINE COMMERCIAL CONST INC. SUPERIOR CONTRACTING SERVICES SUPERIOR CONTRACTING SVC INC. SURBER DRYWALL CONSTRUCTION SWINERTON BUILDERS T & J FLOORS TEAM GLASS INC TECHNO COATINGS INC TELESIS DESIGN BUILD LLC THE WESTIN ST FRANCIS THE WRIGHT SOLUTION, LLC. TISYS CONSTRUCTION TOTAL PROCESS SYSTEMS INC. TRILLIUM GLASS INC. U S GLASS & ALUM INC-NEVADA U-NEAC FRAMING & DRYWALL, INC. U.S. GLASS, INC. U.S.G.A., INC UNION ROLLING DOOR CO., INC UNITED CALIF ACCESS & SEC SYS UNITED CALIFORNIA GLASS & DOOR UNIVERSAL FLOORING INC US NATIONAL CORP US NATIONAL CORP DBA JIMENEZ P VALDEZ PAINTING, INC. VALLEY GLASS CO VALLEY WATERPROOFING INC VPM GENERAL BUILDING, LLC WALTERS & WOLF GLASS COMPANY WALTERS & WOLF INTERIORS WEBCOR CONSTRUCTION, LP WEISS SHEET METAL/METCOE SKYLI WEST COAST DRYWALL WEST COAST INDUSTRIAL COATINGS WESTERN ADDITION DRYWALL WESTERN TILE & MARBLE INC WESTLAKE VILLAGE APARTMENTS WESTPAC ARCHITECTURAL WILSON & HAMPTON PAINTING CONT WM B SALEH PAINTING WM B SALEH PAINTING INC WOODBRIDGE GLASS, INC. WORK PRESERVATION FUND, INC.