2013-04-01T09:45:22-05:00 2012-05-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WE BETHESDA MD 20814 990 2011-06-01 204570305 LONG TERM CARE WORKERS HEALTH TRUST FUND LONG 2133660688 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 LAPHONZA BUTLER 2133660688 2013-04-01 1 SCOTT E HALLBERG P01081188 2023319880 2011 2016-02-25 16:41:14Z LAPHONZA BUTLER 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 21526483 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 4 0 0 0 0 0 0 20575173 17909063 14824 24477 1483809 3592943 22073806 21526483 0 0 18621252 14257317 0 0 0 0 0 4376265 1088788 22997517 15346105 -923711 6180378 8616883 12095580 3772394 1070713 4844489 11024867 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 0 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 0 1 361 0 1 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 CA X ATPA 6262793003 4399 SANTA ANITA AVENUE STE 200 EL MONTE CA 91731 LAPHONZA BUTLER 1.00 X 0 170916 25192 SAMUEL COOK 1.00 X 0 137289 44213 ROSA MUNDY 1.00 X 0 0 0 DAVID WERLIN 1.00 X 0 0 0 0 308205 69405 2 0 1 0 ANTHEM BLUE CROSS AND BLUE SHIELD 370 BASSETT ROAD NORTH HAVEN CT 06473 CLAIMS ADMINISTRATOR FEES 333805 ATPA 4399 SANTA ANITA AVE 200 EL MONTE CA 91731 ADMINISTRATOR FEES 294928 SCHWARTZ STEINSAPIR DOHRMANN & SOMMERS 6300 WILSHIRE BOULEVARD SUITE 2000 LOS ANGELES CA 90048 LEGAL FEES 170556 SEGAL COMPANY 330 N BRAND BLVD GELNDALE CA 91203 ACTUARY 109316 4 EMPLOYER CONTRIBUTIONS 900099 17373961 17373961 PARTICIPANT CONTRIBUTI 900099 535102 535102 17909063 24477 24477 SETTLEMENT INCOME 900099 3478703 3478703 EXPRESS SCRIPTS REBATE 900099 108325 108325 MISCELLANOUS INCOME 900099 5915 5915 3592943 21526483 21502006 0 24477 14257317 202976 27000 109316 69766 47845 ADMINISTRATOR FEES 628733 OTHER EXPENSES 3152 15346105 5996777 9346211 2088560 2240458 86 4227 531460 504684 8616883 12095580 3772394 1070713 3772394 1070713 X 4844489 11024867 4844489 11024867 8616883 12095580 6180378 0 X 0 1 0 X 0 0 21526483 15346105 6180378 6180378 21526483 0 21526483 0 21526483 15346105 0 15346105 0 15346105 0 0 0 LAPHONZA BUTLER 0 170916 0 0 0 0 0 15820 0 9372 0 196108 0 0 SAMUEL COOK 0 137289 0 0 0 0 0 16845 0 27368 0 181502 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE TRUSTEE REVIEWS THE FORM 990 BEFORE FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ANY OF ITS DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC. SEIU UNITED LONG-TERM CARE WORKERS LOCAL UNION NO 6434 2515 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 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0