2016-12-08T14:32:10-06:00 2016-02-29 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2015-03-01 942260587 HEALTH SERVICES FOUNDATION HEAL 9258337300 4160 DUBLIN BLVD NO 400 DUBLIN CA 94568 RICHARD MUTO PRESIDENT 9258337300 2016-12-08 1 JOSEPH THIERMANN P01066616 9252779100 2015 2017-02-10 21:41:12Z RICHARD MUTO 4160 DUBLIN BLVD NO 400 DUBLIN CA 94568 1414054 0 X N/A X 1974 CA TO PROVIDE MEDICAL EXAMINATIONS TO MEMBERS 7 7 13 0 0 0 0 0 1538260 1413996 289 58 0 0 1538549 1414054 0 0 0 0 348530 377902 0 0 0 784672 1015207 1133202 1393109 405347 20945 2266130 1927320 649863 290108 1616267 1637212 TO PROVIDE MEDICAL EXAMINATIONS FOR MEMBERS AND THEIR DEPENDENTS PRIMARILY IN THE CANNING, DEHYDRATION, AND FREEZER INDUSTRIES, AND TO PROVIDE ADMINISTRATIVE SERVICES TO ADMINISTRATORS OF TAFT HARTLEY TRUST FUNDS. 0 0 829620 1413996 PROVIDED MEDICAL EXAMINATIONS FOR MEMBERS AND THEIR DEPENDENTS PRIMARILY IN THE CANNING, DEHYDRATION, AND FREEZER INDUSTRIES AND PROVIDED ADMINISTRATIVE SERVICES TO TAFT HARTLEY TRUST FUNDS. 829620 0 0 0 0 0 0 0 0 0 1 1 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 0 0 0 0 0 1 12 0 1 13 1 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 1 0 X MIGUEL TAIME 9258337300 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 RICHARD MUTO PRESIDENT & DIRECTOR 1.50 X X 6000 0 0 PAUL BERG DIRECTOR 1.50 X X 6000 0 0 GARY LISK DIRECTOR 1.50 X X 6000 0 0 JOHN HURLEY DIRECTOR 1.50 X X 6000 0 0 DAVID J MACKENZIE VICE PRESIDENT & DIRECTOR 1.50 X X 6000 0 0 NELSON L ROBBINS TREASURER & DIRECTOR 1.50 X X 6000 0 0 LUIS DIAZ SECRETARY & DIRECTOR 1.50 X X 6000 0 0 42000 0 0 0 0 0 0 HEALTH SERVICES BENEFIT ADMINISTRATORS 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 MANAGEMENT SERVICES 379992 QUEST DIAGNOSTICS PO BOX 740709 ATLANTA GA 30374 LABORATORY WORK 127494 2 FEES FOR WELLNESS TEST 900099 1413996 1413996 1413996 58 58 1414054 1413996 0 58 X 42000 42000 312377 312377 23525 23525 440232 440232 306 306 24025 24025 200916 200916 8036 2092 5944 57364 55540 1824 36565 36565 12194 11436 758 33755 29564 4191 41714 2414 39300 54619 54619 30062 30062 TRAILER MOVING 45624 45624 MEDICAL SUPPLIES 20009 20009 OTHER EXPENSES 4161 4161 PENSION EXPENSE AND ADM 4000 4000 1625 716 909 1393109 829620 563489 0 1487404 1549317 19553 48003 23340 589337 517149 117832 72188 612891 262922 2266130 1927320 36972 27186 612891 262922 649863 290108 X 1616267 1637212 1616267 1637212 2266130 1927320 20945 0 X X 0 1 X 1 0 589337 517149 72188 72188 ASSETS (MUTUAL FUNDS) HELD IN RABBI TRUST 262922 F 262922 SEVERANCE DUE TO FORMER EMPLOYEES 262922 262922 X 1414054 0 1414054 0 1414054 1393109 0 1393109 0 1393109 PART X, LINE 2: THE ORGANIZATION HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION, AND HAS CONCLUDED THAT, AS OF FEBRUARY 29, 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 ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE ORGANIZATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2013. FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF DIRECTORS HAS HIRED HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC. TO PROVIDE CERTAIN MANAGEMENT FUNCTIONS UNDER A WRITTEN CONTRACT. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE A COMMITTEE TO ACT WITH AUTHORITY ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES THAT EACH DIRECTOR, OFFICER AND MANAGEMENT EMPLOYEE WITH DELEGATED POWERS WHO CAN INFLUENCE THE ACTIONS OF THE ORGANIZATION SHALL ANNUALLY SIGN A STATEMENT THAT AFFIRMS THEY HAVE RECEIVED A COPY OF THE CONFLICT-OF-INTEREST POLICY, THEY HAVE READ AND UNDERSTAND THE POLICY, AND THEY AGREE TO COMPLY WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15B THE BOARD OF DIRECTORS HAVE APPROVED A $500/MONTH HONORARIA STIPEND FOR ALL DIRECTORS, WHICH IS INCLUDED IN THE ANNUAL BUDGET AND APPROVED BY THE DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL INFORMATION AVAILABLE TO PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL DIRECTOR : PROGRAM SERVICE EXPENSES 42,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,000. LABORATORY PROC : PROGRAM SERVICE EXPENSES 127,494. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,494. LIFESTYLE MANAGEMENT FEES : PROGRAM SERVICE EXPENSES 28,616. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,616. PAYROLL PROCESSING : PROGRAM SERVICE EXPENSES 2,806. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,806. FORM 990, PART XII, LINE 2C: EXPLANATION: THE BOARD OF DIRECTORS IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED.