2015-02-20T14:03:26-06:00 2014-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY 400 SAN RAMON CA 94583 990 2013-05-01 941206350 CALIFORNIA SVC EMPLOYEES HEALTH & WELFARE TRUST FUND CALI 5104334452 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 CHARLIE GILCHRIST TRUSTEE 5104334452 2015-02-20 1 DEBBIE ROESSL DIMERY P01065763 9252779100 2013 2016-02-25 16:41:14Z CHARLIE GILCHRIST 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 130045230 0 X N/A X 1951 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 5 0 31 0 0 0 0 0 94158492 98023797 -770405 1866274 0 0 93388087 99890071 0 0 93891598 100907982 522139 623140 0 0 0 2094657 2203538 96508394 103734660 -3120307 -3844589 145208854 139269189 25229858 22298563 119978996 116970626 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 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 1 255 0 1 31 1 0 0 0 0 0 0 X 5 0 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 1 1 0 X ASSOC THIRD PARTY ADMINISTRATORS 5104334452 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 DAVID STILWELL ALTERNATE TRUSTEE 0.50 X 0 0 0 MIKE GARCIA TRUSTEE 0.30 X 0 0 0 CHARLES GILCHRIST TRUSTEE 5.00 X 18000 0 25351 RAY NANN TRUSTEE 5.00 X 18000 0 25351 LARRY T SMITH TRUSTEE 5.00 X 18000 0 25351 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 0 0 54000 0 76053 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 989 MARKET STREET SUITE 320 SAN FRANCISCO CA 94104 FUND ADMINISTRATION 792985 LINDQUIST LLP 5000 EXECUTIVE PARKWAY STE 400 SAN RAMON CA 94583 AUDITING AND ACCOUNTING SERVICES 260651 SALTZMAN & JOHNSON 44 MONTGOMERY ST SUITE 2110 SAN FRANCISCO CA 94104 ATTORNEY 178697 MCMORGAN & COMPANY 425 MARKET STREET SUITE 1600 SAN FRANCISCO CA 94105 INVESTMENT MANAGER 149065 THE SEGAL COMPANY 100 MONTGOMERY ST SUITE 500 SAN FRANCISCO CA 94104 CONSULTANT 128595 5 EMPLOYER CONTRIBUTIONS 900099 96373015 96373015 EMPLOYEE CONTRIBUTIONS 900099 805189 805189 STOP LOSS INCOME 900099 774943 774943 PRESCRIPTION CLAIMS REBATE 900099 69185 69185 OTHER INCOME 900099 1465 1465 98023797 2129481 2129481 29891952 30155159 -263207 -263207 -263207 99890071 98023797 0 1866274 100907982 134844 322836 43948 82527 38985 811044 186656 211029 195213 377663 239539 25920 2040 22866 127778 OTHER EXPENSE 3790 103734660 224947 505299 10694566 10037267 11392674 11609833 74188 79603 120804544 116522410 2017935 514777 145208854 139269189 181487 116563 25048371 22182000 25229858 22298563 X 0 0 0 0 119978996 116970626 119978996 116970626 145208854 139269189 -3844589 836219 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 21155000 CLAIMS PAYABLE AND IBNR 846000 GROUP INSURANCE PREMIUMS PAYABLE 181000 22182000 X 100531077 836219 836219 99694858 195213 195213 99890071 103882447 0 103882447 195213 -343000 -147787 103734660 PART X, LINE 2: THE PLAN'S ADMINISTRATORS HAVE ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAVE CONCLUDED THAT AS OF APRIL 30, 2014, 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 APRIL 30, 2011. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH ASSOCIATED THIRD PARTY ADMINISTRATORS TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES REVIEWS AND APPROVES COMPENSATION FOR THE PLAN'S EMPLOYEES BASED ON STAFF CLASSIFICATIONS AND WAGE SCALES ALONG WITH OTHER DATA AVAILABLE. THE COMPENSATION FOR THE TRUSTEES IS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES BASED ON THE AMOUNT OF TIME THE TRUSTEES SPEND PERFORMING THEIR DUTIES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND FOR SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. FORM 990, PART VII, SECTION A, LINE 1A: SOME TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. FOR ADDITIONAL INFORMATION, CONTACT THE THIRD-PARTY ADMINISTRATOR, ASSOCIATED THIRD PARTY ADMINISTRATORS. SERVICE EMPLOYEES INTERNATIONAL UNION LOCAL 1877 828 WEST WASHINGTON BLVD LOS ANGELES CA 90015 770214817 LABOR UNION CA 501(C)(5) N/A SERVICE EMPLOYEES INTERNATIONAL UNION 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 APRIL 30, 2014, THERE ARE APPROXIMATLEY 78 EMPLOYERS THATS 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 (DISREGARDING 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 MAINTENANCE ENTERPRISE INC ABLE BLDG MAINT CO ABM AEROPORT SERVICES, INC. AIR SERV CORPORATION ALBERTSON'S INC-DOWNEY AMERICAN BLDG MAINT APPRENTICE & JOURNEYMAN ARAMARK - GALEN CENTER ARAMARK FACILITY SERVICES ARAMARK SERVICEMASTER AVIATION SAFEGUARDS-LAX BLACKSTONE CONSULTING BUNKER HILL TOWER CONDO ASSN CALOP AEROGROUND SERVICES CENTENNIAL ONE OF WASHINGTON, INC COLUMBIA CLEANING CO DEL MAR THOROUGHBRED CLUB DIVERSIFIED MAINT SVC ESC BUILDING SERVICES F E CAMPBELL/CENTURY DENTAL PL FACILITIES SUPPORT SERVICES FLAGSHIP FACILITY SVCS, INC. G2 SECURE STAFF - LAX GATEWAY GROUP ONE GCA SERVICES GROUP CO. GELSON'S MARKETS GUARANTEE PEST CONTROL, INC HEALTH & WELFARE OFFICE STAFF HEALTH & WELFARE TRUSTEES HOTEL, RESTAURANT EE'S & HYATIP REGENCY CENTURY PI/ HTL ILWU HALL, LOCAL NO. 10 INNOVATIVE JANITORIAL SERVICE JANITORIAL EQUIPMENT SVCS, INC JMS/PARAMOUNT KLEENHOUSE BUILDING MAINTENANCE KOHL BUILDING MAINTENANCE LA ARENA CO, LLC LA HABRA 300 BOWL LOCAL 280 PARIMUTUEL EMPLOYEES LOCAL 99 LA CITY AND CNTY SCHL EES LOS ANGELES DODGERS, INC MERCHANTS BUILDING MAINT METRO SERVICE SOUTH, INC MI FAMILIA VOTA MILLENNIUM BILTMORE HOTEL NATIONAL BLDG SVCS NATIONWIDE JANITORIAL SERVICE ONE STOP BUILDING MAINT. PACIFIC BUILDING CARE PEERLESS BLDG MAINT PEGASUS BUILDING SERVICES PROFESSIONAL MAINTENANCE SYSTEMS RACE TRACK L-1877 RACE TRACK L-280 RALPH'S GROCERY CO. REGENT BEVERLY WILSHIRE HOTEL, INC SAN DIEGO SPORTS ARENA/LA ARENA CO SANSTRAND SERVICES SDH SERVICES WEST, LLC SEIU LOCAL 121RN SERVICON SYSTEMS, INC SIGNATURE MAINTENANCE SODEXO SOMERS BUILDING MAINTENANCE STATER BROS MARKETS STEAMFITTERS LOCAL UNION NO. 250 SUNRISE FLOOR SYSTEMS, LLC SUPER A FOODS TOWNSHIP BUILDING MAINTENANCE UGL UNICCO/DTZ, INC. UNITED BLDG SERVICE/ABLE UNIVERSAL BLDG MAINT US METRO GROUP VON'S GROCERY COMPANY WILSHIRE TERRACE APTS. WORLD SERVICE WEST- LAX