2013-09-11T19:24:20-05:00 2012-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2012-01-01 946171641 STATIONARY ENGINEERS LOCAL 39 HEALTH AND WELFARE PLAN STAT 9252089999 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 PAUL BENSI 9252089999 2013-09-11 1 JOSEPH M THIERMANN P01066616 9252779100 2012 2016-02-24 21:20:13Z PAUL BENSI 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 59988109 0 X N/A X 1965 CA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS 4 0 0 0 0 0 0 0 53700935 58461916 1936073 1526193 0 0 55637008 59988109 0 0 52491773 57401593 0 0 0 0 0 1377856 1622862 53869629 59024455 1767379 963654 38006206 42105841 12120964 13398273 25885242 28707568 TO PROVIDE MEDICAL, DENTAL, VISION AND LIFE INSURANCE BENEFITS TO ELIGIBLE MEMBERS OF THE PLAN AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH & 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 1 158 0 1 0 0 0 0 0 0 0 X 4 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X BENESYS INC 9252089999 7180 KOLL CENTER PARKWAY 200 PLEASANTON CA 94566 X JERRY KALMAR 1.00 X 0 0 0 BART FLORENCE 1.00 X 0 0 0 PAUL BENSI 1.00 X 0 0 0 LYLE SETTER 1.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS 7180 KOLL CENTER PKWY SUITE 200 PLEASANTON CA 94566 THIRD PARTY ADMINISTRATION SERVICES 634363 WEINBERG ROGER & ROSENFELD 1001 MARINA VILLAGE PKWY SUITE 200 ALAMEDA CA 94501 LEGAL SERVICES 327235 DELTA DENTAL PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS ADMINISTRATION FEES 253743 ANTHEM BLUE CROSS 2121 N CALIFORNIA BLVD 700 WALNUT CREEK CA 94596 CLAIMS ADMINISTRATION FEES 108346 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 5000 SAN RAMON CA 94583 ACCOUNTING SERVICES 102808 5 EMPLOYER CONTRIBUTIONS 900099 56761245 56761245 PARTICIPANT CONTRIBUTIONS 900099 1145642 1145642 STOP LOSS REIMBURSEMENT 900099 314644 314644 OTHER INCOME 900099 187804 187804 PRESCRIPTION DRUG REBATE 900099 52581 52581 58461916 1526193 1526193 59988109 58461916 0 1526193 57401593 613556 333325 102808 16000 462084 58396 11487 25206 59024455 3100917 3381462 2418199 1742072 4876750 5374044 132796 0 27477544 31608263 38006206 42105841 2480265 3028568 96699 96705 9544000 10273000 12120964 13398273 X 0 0 0 0 25885242 28707568 25885242 28707568 38006206 42105841 963654 1858672 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 10273000 10273000 X 61830781 1858672 1858672 59972109 16000 16000 59988109 57636139 0 57636139 16000 1372316 1388316 59024455 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMEBER 31, 2012, 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'S ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION FOR THE YEARS PRIOR TO THE FISCAL YEAR ENDING DECEMEBER 31, 2009. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH BENESYS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO EACH OF THE VOTING MEMBERS WITHIN THE ORGANIZATION'S GOVERNING BODY TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY COMPLYING WITH ALL APPLICABLE PROVISIONS OF ERISA, INCLUDING PARTY IN INTEREST AND CONFLICT OF INTEREST PROVISIONS OF ERISA SECTION 406. ANY CONFLICTS OR POTENTIAL CONFLICTS ARE REPORTABLE TO THE CHAIRMAN OF THE BOARD OF TRUSTEES AND LEGAL COUNSEL FOR THE PLAN. 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. STATIONARY ENGINEERS LOCAL 39 PENSION 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 946118939 UNION PENSION PLAN CA 501(A) N/A N/A 0 STATIONARY ENGINEERS LOCAL 39 ANNUITY 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 942787714 UNION ANNUITY PLAN CA 501(A) N/A N/A 0 IUOE STATIONARY ENGINEERS LOCAL NO 39 337 VALENCIA STREET SAN FRANCISCO CA 94103 941056580 LOCAL UNION 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 PARTIES: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF 12/31/12, THERE ARE APPROXIMATELY 156 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. 11TH & 'L' BUILDING 500 CAPITOL MALL TOWER LLC ABLE ENGINEERING SERVICES ABM ENGINEERING SERVICES ACEPEX MANAGEMENT CORPORATION AEG MANAGEMENT OAKLAND, LLC AIRCON ENERGY ALEUT FACILITY SUPPORT SERVICES LLC ALSCO - SAN JOSE ALSCO SAN FRANCISCO ALTA BATES HOSPITAL ASCO SERVICE INC AT YOUR SERVICE HEATING & COOLING, LLC B&W CONTRACT SERVICES INC BENTLY HOLDINGS CALIFORNIA BERKELEY FARMS INC HAYWARD BIMBO BAKERIES/SARA LEE (FRESNO) BIMBO BAKERIES/SARA LEE (OAKLAND) BIMBO BAKERIES/SARA LEE (SACRAMENTO) BOHANNON DEVELOPMENT COMPANY BRANDYWINE REALTY TRUST BROADWAY REAL ESTATE SERVICES BROOKFIELD PROPERTIES, LLC BROOKS RANGE CONTRACT SERVICES CALFOX CALIFORNIA DAIRIES INC CALIFORNIA PACIFIC MEDICAL CENTER CALIFORNIA SHELLFISH COMPANY CALIFORNIA SPRAY DRY COMPANY CATHEDRAL HILL PLAZA ASSOCIATES CB RICHARD ELLIS CBRE TECHNICAL SERVICES CHINESE HOSPITAL CITY OF COLFAX CLAREMONT RESORT INC CLIFT HOTEL, THE COLFAX CEMETERY/COUNTY OF PLACER COLLIERS INTERNATIONAL COMPLETE BUILDING SERVICES CROSSPOINT REALTY SERVICES CROWNE PLAZA SAN FRANCISCO INT'L AIRPORT CUSHMAN AND WAKEFIELD CUSHMAN AND WAKEFIELD DAUGHTERS OF CHARITY - SETON MED CNTR/COASTSIDE DAUGHTERS OF CHARITY - SETON MEDICAL CENTER DIGNITY HEALTH - SEQUOIA HOSPITAL DIGNITY HEALTH - ST. FRANCIS HOSPITAL DIGNITY HEALTH - ST. MARY'S HOSPITAL DOCTORS MEDICAL CENTER SAN PABLO DONOHOE & COMPANY INC. DOUBLETREE HOTEL ENOVITY, INC. EQUITY OFFICE PROPERTIES FAIRMONT HOTEL, SAN JOSE FOUR SEASONS HOTEL, SF GRAMERCY TOWERS COMPANY GRAND HYATT SAN FRANCISCO GROWERS ICE COMPANY GRUBB & ELLIS MANAGEMENT SERVICES, INC. HANDLERY UNION SQUARE HOTEL HEARST CORPORATION HERRICK HOSPITAL & HEALTH CENTER HILTON FINANCIAL DISTRICT HINES HOLIDAY INN CIVIC CENTER HOLIDAY INN FISHERMAN'S WHARF HOLIDAY INN GOLDEN GATEWAY HOSTESS BRANDS HOTEL NIKKO SAN FRANCISCO HOTEL SOFITEL, SF BAY HP HOOD, LLC. / CROWLEY FOODS HYATT REGENCY SACRAMENTO HYATT REGENCY SAN FRANCISCO HYATT REGENCY SF AIRPORT INTERCONTINENTAL SAN FRANCISCO HOTEL ISS FACILITY SERVICES IUOE LOCAL 39 IUOE LOCAL 39 - SACRAMENTO TRAINING CENTER J.W. MARRIOTT HOTEL JOHN MUIR MEDICAL CENTER/CONCORD CAMPUS JOHNSON CONTROLS, INC. JONES LANG LASALLE SERVICES JONES LANG LASALLE SERVICES (SACRAMENTO) K CORP TECHNOLOGY SERVICES, INC. KABUKI HOTEL KINGS-ARCO ARENA, LP KINGSBURY GID KURTZERS HEATING & AIR CONDITIONING LANDMARK EXCHANGE MANAGEMENT, INC. LEE'S APPLIANCES, INC. LEGACY MECHANICAL & ENERGY SERVICES, INC. LEO EPP COMPANY MARK HOPKINS HOTEL MARRIOTT OAKLAND CITY CENTER MARRIOTT-FISHERMAN'S WHARF MATRIX, H.G., INC. MERIDIAN MANAGEMENT COMPANY METRO MAINTENANCE MJM MANAGEMENT GROUP /DBA/ YERBA BUENA GARDENS NEW SOUTH PARKING (FORMERLY AMPCO - SFO) NORTH TAHOE PUD NORTHERN MANAGEMENT SERVICES NOTRE DAME DE NAMUR UNIVERSITY OAKLAND AIRPORT HILTON O'CONNOR HOSPITAL OLYMPIC CLUB, THE OROWEAT SALES CO., A DIVISION OF BIMBO PALACE HOTEL PARC 55 HOTEL MANAGEMENT, LLC PRIDE INDUSTRIES RELIABLE BUILDING MAINTENANCE RNM PROPERTIES ROCKEFELLER GROUP INTERNATIONAL INC. ROUND HILL GENERAL SAFEWAY STORES, BAKERY 8122 SAFEWAY STORES, INC. (MILK PLANT) SAINT LOUISE REGIONAL HOSPITAL SAN FRANCISCO CONSERVATORY OF MUSIC SAN FRANCISCO HILTON SAN FRANCISCO MARRIOTT SAN FRANCISCO MARRIOTT UNION SQUARE SAN JOSE ARENA MANAGEMENT, INC. SAN JOSE HILTON & TOWERS SANTA CLARA CHAMBER OF COMMERCE SANTA ROSA MEMORIAL HOSPITAL SAPUTO DAIRY FOODS USA, LLC SHASTA LINEN SUPPLY, INC. SHERATON FISHERMAN'S WHARF SHERATON GRAND SACRAMENTO HOTEL SMG / GEORGE MOSCONE CENTER SMG/OCJ/DBA OAKLAND ALAMEDA COUNTY COLISEUM SMS-VEF IV, LLC ST REGIS HOTEL, THE ST. JOSEPH'S MEDICAL CENTER STANFORD COURT - A RENAISSANCE HOTEL STOCKTON COLD STORAGE SUMMIT MEDICAL CENTER SUNSET DEVELOPMENT COMPANY TISHMAN SPEYER TOWNSHIP ENGINEERING SERVICES UGL SERVICES UNICCO OPERATIONS UNI-KOOL COMPANY (SALINAS) UNIVERSAL PARAGON CORPORATION UNIVERSITY OF SAN FRANCISCO URBAN SERVICES GROUP, INC. VERITAS PROPERTY MANAGEMENT W SAN FRANCISCO HOTEL WEIGEL MECHANICAL WEINBERG ROGER & ROSENFELD WEST COAST REALTIES, HEARST COMMUNICATIONS, INC. WESTERN CONFERENCE OF OPERATING ENGINEERS WESTIN SAN FRANCISCO MARKET STREET WESTIN ST. FRANCIS WORLEYPARSONS CONSTRUCTORS, INC.