2022-03-23T09:07:27-05:00 2021-06-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2020-07-01 946251593 NORTHERN CALIFORNIA PLASTERERS HEALTH AND WELFARE TRUST FUND NORT 9258337300 4160 DUBLIN BLVD NO 400 DUBLIN CA 94568 NANCY BRINKERHOFF TRUSTEE 9258337300 2022-03-23 1 NANCY BRINKERHOFF 999009999 SUNYOUNG BAEK P01451883 9252779100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z NANCY BRINKERHOFF 4160 DUBLIN BLVD NO 400 DUBLIN CA 94568 17584588 0 X N/A X 1953 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS AND THEIR DEPENDENTS. 8 0 0 0 0 0 0 0 13523907 13088578 594064 923365 0 0 14117971 14011943 0 0 12208848 13281606 0 0 0 0 0 539826 554280 12748674 13835886 1369297 176057 25717738 26810682 7518449 7142322 18199289 19668360 TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO 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 3 0 1 0 0 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 X HEALTH SERVICES & BENEFIT ADMINISTRATORS 9258334337 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 X NANCY BRINKERHOFF CHAIR 1.00 X 0 0 0 ROGER HENLEY TRUSTEE 1.00 X 0 0 0 JAMES RUANE TRUSTEE 1.00 X 0 0 0 CHET O'DONNELL TRUSTEE - PAST 1.00 X 0 0 0 MARSHALL VASQUEZ TRUSTEE 1.00 X 0 0 0 EMILIO ALDANA CO-CHAIR & SECRETARY 1.00 X 0 0 0 ROBERT NOTO TRUSTEE 1.00 X 0 0 0 ISRAEL VARGAS TRUSTEE 1.00 X 0 0 0 SHAWN ALVARADO 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 HS&BA 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 CONTRACT ADMINISTRATION 168180 LINDQUIST LLP 5000 EXECUTIVE PKWY SUITE 400 SAN RAMON CA 94583 ACCOUNTING & AUDITING 109987 2 EMPLOYER CONTRIBUTIONS 900099 12312948 12312948 PARTICIPANT CONTRIBUTIONS 900099 737827 737827 LIQUIDATED DAMAGES AND OTHER INCO 900099 37803 37803 13088578 323878 323878 4172132 3572645 599487 599487 599487 14011943 0 0 14011943 13281606 159550 48804 102126 49806 138598 35874 1065 16900 MISCELLANEOUS 1557 13835886 6819577 5923157 57611 65885 1197621 958109 8615 7543 17634314 19855988 25717738 26810682 82590 33721 7435859 7108601 7518449 7142322 X 0 0 0 0 18199289 19668360 18199289 19668360 25717738 26810682 176057 1293014 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 5266000 DUE TO RELATED ENTITIES 1786726 PREMIUM PAYABLE 10801 CLAIMS PAYABLE AND IBNR 45074 7108601 X 15255151 1293014 1293014 13962137 49806 49806 14011943 14156067 0 14156067 49806 -369987 -320181 13835886 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF JUNE 30, 2021, 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 THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2018. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE GOVERNING BODY HAS APPOINTED MANAGEMENT DUTIES TO A THIRD-PARTY ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS 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 RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE TAX EXEMPT ORGANIZATIONS. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE ADMINISTRATOR. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. NORTHERN CALIFORNIA PLASTERERS PENSION PLAN 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 946129382 TO PROVIDE RETIREMENT BENEFITS TO ELIGIBLE PARTICIPANTS CA 501A N/A N/A 0 PLASTERERS LOCAL 66 RETIREMENT PLAN 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 946273369 TO PROVIDE RETIREMENT BENEFITS TO ELIGIBLE PARTICIPANTS CA 501A N/A N/A 0 PLASTERERS & CEMENT MASONS LOCAL 300 8400 ENTERPRISE WAY SUITE 111 OAKLAND CA 94621 943249920 IMPROVE UNION MEMBERS' WELFARE CA 501(C)5 N/A N/A 0 PLASTERERS LOCAL 66 39 SOUTH LINDEN AVENUE S SAN FRANCSICO CA 94080 946243230 IMPROVE UNION MEMBERS' WELFARE 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 DEPENDENTS. AS OF JUNE 30, 2021, THERE ARE APPROXIMATELY 67 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 REPORTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. ACCURATE FIRESTOP INC. ADAMS POOL SOLUTIONS ALB INC. ALCAL SPECIALTY CONTRACT AMERICAN FIREPROOFING INC AMERICAN NATIONAL INSULATION ANNING JOHNSON COMPANY APPLIED RESTORATION INC. BERG PLASTERING LLC BEST CONTRACTING BOYETT CONSTRUCTION INC. BRADY CO/CENTRAL CA INC CALIFORNIA DRYWALL CO. CLASSIC FINISHES LLC COR RAY PAINTING CO. CUSTOM SPRAY SYSTEMS DALEY'S DRYWALL TAPING DEPT OF CORRECTIONS & REHABILITATION DMS DRYWALL & INTERIOR SYSTEMS INC. ELITE PLASTERING F.C. BICKERT CO **DAS** F-3 FIREPROOFING INC FREAS PLASTERING COMPANY FREY PLASTERING INC FRIIS PLASTERING - NON BARGAINING GORDON PLASTERING INC. HARRISON DRYWALL HARTLEY CONSTRUCTION INC. HENLEY & CO HINDS BROTHERS CO INC IRONWOOD COMMERCIAL BUILD J J ACOUSTICS INC JACKSON QUALITY DRYWALL KARSYN CONSTRUCTION KHS & S CONTRACTORS INC LEVEL 5 INC MAGNUM DRYWALL METCALF INC. MIRAGE BUILDERS INC NATIONAL PLASTERING IND. NATIONAL PLASTERING IND. NEVELL GROUP INC NEVELL-STANDARD J.V. LLC O'DONNELL PLASTERING INC OLEA PLASTERING ONYX BUILDING GROUP INC OPCMIA LOCAL 300 - HOURLY PACIFIC WEST LATH PATRICK J RUANE INC PERFORMANCE CONTRACTING PLASTERERS CEMENT 797 PLASTERERS CEMENT JATC - NB 300/HRLY PLASTERERS LOCAL 66 PLASTERERS MGMT COMMITTEE - HOURLY RAYMOND NORTHERN CALIFORNIA INC REX ALVERA PLASTERING D.A.S RFJ MEISWINKEL CO ROBERT BOEGER ROLLING PLAINS CONSTRUCT RUTHERFORD CO. INC. S & R DRYWALL INC. SERVICE PLASTERING II SUPERIOR STUCCO *DAS* TARLTON & SON INC UNIVERSAL LP CORP VALDEZ PLASTERING INC. WESTERN PARTITIONS INC