2022-05-10T12:21:17-05:00 2021-06-30 222027092 WITHUMSMITHBROWN PC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2020-07-01 943254224 UA LOCAL NO 355 HEALTH AND WELFARE TRUST FUND UALO 4155467800 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 FELIPE HERNANDEZ TRUSTEE 4155467800 2022-05-10 1 FELIPE HERNANDEZ 999009999 JESSICA R ROSTER P01317380 9252779100 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z SCOTT STRAWBRIDGE 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 10510100 0 X N/A X 1993 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 4 0 0 0 0 0 0 0 3714708 3310947 47658 408262 420 60 3762786 3719269 0 0 2267247 2135243 0 0 0 0 0 431721 417725 2698968 2552968 1063818 1166301 8269839 9501059 1244707 1013815 7025132 8487244 PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 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 0 0 1 0 0 0 0 0 0 0 0 0 X 4 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X ZENITH ADMINISTRATORS 2062824100 201 QUEEN ANNE AVE N SUITE 100 SEATTLE WA 98109 X SCOTT STRAWBRIDGE TRUSTEE 0.20 X 0 0 0 FELIPE HERNANDEZ TRUSTEE 0.20 X 0 0 0 GARY WILLIAMS TRUSTEE 0.20 X 0 0 0 EMIDIO LOPEZ TRUSTEE 0.20 X 0 0 0 ALEX HALL TRUSTEE - PAST 0.20 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 ZENITH AMERICAN SOLUTIONS 201 QUEEN ANNE AVE NORTH 100 SEATTLE WA 98109 ADMINISTRATOR 107393 1 EMPLOYER CONTRIBUTIONS 900099 3194741 3194741 STOP LOSS REFUNDS 900099 116206 116206 3310947 150207 150207 7048886 6790831 258055 258055 258055 PRESCRIPTION DRUG REBATES 900099 60 60 60 3719269 3311007 0 408262 2135243 226669 30328 75132 46 34650 34296 12 420 16172 2552968 3655159 1097207 102812 102915 303571 250699 1879 2495 4206418 8047743 8269839 9501059 35558 38759 1209149 975056 1244707 1013815 X 0 0 0 0 7025132 8487244 7025132 8487244 8269839 9501059 1166301 129904 165907 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 670400 TRANSIT FUNDS-HELD IN TRUST 124456 CLAIMS PAYABLE & IBNR 180200 975056 X 3849127 129904 129904 3719223 46 46 3719269 2614334 0 2614334 46 -61412 -61366 2552968 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS 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 IT 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 TRUST CONTRACTED WITH ZENITH AMERICAN SOLUTIONS, INC. TO PROVIDE ADMINISTRATIVE SERVICES TO THE PLAN. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE IT WAS FILED. 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 THE OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. THE ORGANIZATION'S OTHER LIABILITIES AT THE BEGINNING OF THE YEAR WERE OVERSTATED BY $165,907. A PRIOR PERIOD ADJUSTMENT WAS REPORTED TO CORRECT THE OVERSTATEMENT. NO CALIFORNIANO NEVADA LANDSCAPE & UNDERGROUND UTILITY JATC 13 TENNESSEE STREET VALLEJO CA 94590 686091014 EDUCATING AND TRAINING JOURNEYMEN AND APPRENTICES CA 501(C)(5) N/A N/A 0 LOCAL UNION 355 UA PLUMBING & PIPEFITTING IND OF THE US & CANADA 13 TENNESSEE STREET VALLEJO CA 94590 680189344 PLAN SPONSOR CA 501(C)(5) N/A N/A 0 UA LOCAL NO355 HIRING HALL ADMINISTRATION TRUST FUND 13 TENNESSEE STREET VALLEJO CA 94590 686095525 PROVIDE JOBS FOR THEIR MEMBERS CA N/A T 0 UA LOCAL 355 JOINT-LABOR MGMT COOPERATION CTTEE TRUST FUND 13 TENNESSEE STREET VALLEJO CA 94590 943201019 FOSTER RELATIONS BETWEEN LABOR AND MANAGEMENT CA N/A T 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 SCHEDULE R - IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTI-EMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYERS AND THEIR DEPENDENTS. AS OF JUNE 30, 2021, THERE ARE APPROXIMATELY 33 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. AMERINE SYSTEMS, INC. ANDREWS VINEYARD, LLC BLANCHARD CONSTRUCTION BORTOLUSSI & WATKIN CALIFORNIA WATERSCAPE CLYDE COLLISHAW SPRINKLERS, INC DAK LANDSCAPE CONSTRUCTION DECKER LANDSCAPING INC DOWDLE & SONS MECHANICAL GREEN GROWTH INDUSTRIES JENSEN CORPORATION JJ NGUYEN, INC KCI ENVIRONMENTAL, INC. LANDSCAPE VISIONS LAWLER & STANZ. INC. LEFEVRE WELDING INC. LEO MANIGLIA ENTERPRISES INC MARINA LANDSCAPE INC MARINA LANDSCAPE INC-RESIDENTL MCGUIRE AND HESTER RMT LANDSCAPE CONTRACTORS, INC SHOOTER & BUTTS, INC. TAKEHARA LANDSCAPE, INC. TAKEHARA LANDSCAPE/MAINTENANCE TRUXELL & VALENTINO LANDSCAPE TRUXELL & VALENTINO UNDERGROUND UTILITY/LANDSCAPE WABO LANDSCAPE & CONSTRUCTION WATERWORKS INDUSTRIES, INC WEST VALLEY CONSTRUCTION CO WESTERN WATER FEATURES, INC WHO BUILT CREATIVE UA LOCAL UNION NO. 355