2022-11-13T13:14:53-06:00 2021-12-31 222027092 WITHUMSMITHBROWN PC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2021-01-01 412261950 DISTRICT COUNCIL 16 OF NORTHERN CALIFORNIA HEALTH & WELFARE TRUST DIST 8009229902 4160 DUBLIN BLVD 400 DUBLIN CA 945687723 ROBERT WILLIAMS III TRUSTEE 8009229902 2022-11-13 1 ROBERT WILLIAMS III 999009999 JOSEPH M THIERMANN P01066616 9252779100 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ROBERT WILLIAMS III 4160 DUBLIN BLVD 400 DUBLIN CA 945687723 141335067 0 X HTTP://WWW.DC16TRUSTFUND.ORG X 2008 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 7 0 105 0 0 0 0 0 139110431 131146187 7971629 5497741 0 0 147082060 136643928 0 0 120509833 124776040 0 0 0 0 0 4602581 4961826 125112414 129737866 21969646 6906062 236884412 250454926 62448784 63032322 174435628 187422604 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 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 1 105 1 0 0 0 0 0 0 0 0 X 7 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICES & BENEFITS ADMINISTRATORS INC 8009229902 4160 DUBLIN BOULEVARD SUITE 400 DUBLIN CA 945687756 X JAMES BOSTER TRUSTEE 1.00 X 0 0 0 MADISON HULL TRUSTEE 1.00 X 0 0 0 JOHN MAGGIORE TRUSTEE 1.00 X 0 0 0 ROBERT WILLIAMS III TRUSTEE 1.00 X 0 0 0 STEVE ECKSTROM TRUSTEE 1.00 X 0 0 0 JAMES HEWETT TRUSTEE 1.00 X 0 0 0 SAL MADRIGAL TRUSTEE 1.00 X 0 0 0 JEANNIE SIMPLEO ALT TRUSTEE 1.00 X 0 0 0 LANCE RYKEN ALT TRUSTEE 1.00 X 0 0 0 FRANK NUNES ALT TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 X 0 1 0 0 1 0 0 0 0 0 HEALTH SERVICES AND BENEFIT ADMINISTRATO 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 FUND ADMINISTRATION 1941183 ANTHEM BLUE CROSS 700 BROADWAY DENVER CO 80273 COST CONTAINMENT 628116 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDITOR 542689 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 BENEFITS ADMINISTRATOR 438229 SALTZMAN AND JOHNSON 44 MONTGOMERY STREET SUITE 2110 SAN FRANCISCO CA 94104 ATTORNEY 332851 9 EMPLOYER CONTRIBUTIONS 900099 121906013 121906013 PARTICIPANT CONTRIBUTIONS 900099 7566843 7566843 PRESCRIPTION REBATES 900099 939225 939225 RETIREE DRUG SUBSIDY 900099 358213 358213 LIQUIDATED DAMAGES 900099 188741 188741 187152 187152 131146187 3141652 3141652 7047228 4691139 2356089 2356089 2356089 136643928 131146187 0 5497741 124776040 2266525 332851 542689 205210 1321529 223466 10926 58630 129737866 25861329 19904777 9765448 4750508 12850563 12237443 17687 9638 188191524 213365970 197861 186590 236884412 250454926 208219 980008 404114 394864 61836451 61657450 62448784 63032322 X 0 0 0 0 174435628 187422604 174435628 187422604 236884412 250454926 6906062 6080914 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 20199893 BENEFIT CLAIMS PAYABLE & IBNR 10475689 EMPLOYER BOND DEPOSITS 79114 CASH BANK LIABILITY 30902754 61657450 X 142519632 6080914 6080914 136438718 205210 205210 136643928 129711657 0 129711657 205210 -179001 26209 129737866 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 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 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 ORGANIZATION HAS DELEGATED CERTAIN MANAGEMENT DUTIES TO A THIRD-PARTY ADMINISTRATOR UNDER THE SUPERVISION OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES IS SUBJECT TO THE FIDUCIARY RESPONSIBILITY PROVISIONS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA), AS AMENDED, INCLUDING THE CONFLICT-OF-INTEREST PROVISIONS OF ERISA SECTION 406. ANNUALLY AT THE BOARD OF TRUSTEES MEETING, THE TRUSTEES ARE REQUIRED TO DISCLOSE IF THERE ARE ANY CONFLICTS OF INTEREST. IF A CONFLICTING INTEREST EXISTS, THE PERSON WITH THE CONFLICT IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION. 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. FORM 990 PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFMORMATION, PLEASE CONTACT THE ADMINISTRATOR. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. DISTRICT COUNCIL NO 16 2705 CONSTITUTION DRIVE LIVERMORE CA 945509206 940433056 EMPLOYEE SPONSORING ORGANIZATION 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 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 DECEMBER 31, 2021, THERE ARE APPROXIMATELY 439 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. A & B PAINTING INC AAC GLASS, INC. ABCO RESTORATION & WATERPROOFI ACR GLASS AND DOORS ADVANCED INDUSTRIAL SERVICES, ADVANTAGE COMMERCIAL SURFACES AHC GLASS CO(SAFECO) AJS PAINTING AKIMA CONSTRUCTION SERVICES LL ALAN GARTHWAITE INDUSTRIES ALCAL GLASS SYSTEMS, INC. ALCOSTA SHOWER DOOR ALL BAY AREA GLASS, INC. ALL COUNTY FLOORING ALL NEW GLASS OF CALIFORNIA ALL STAR CAULKING & WATERPROOF ALLIANCE GLASS COMPANY ALLIED PAINTERS INC ALPHA GLASS COMPANY ALUTECH AMERICAN GLASS ANDRE'S GLASS SERVICE ANDRIANI PAINTING, INC. ANEMOS ENTERPRISES, INC. ANNING & JOHNSON COMPANY APPLIED FINISHES APPLY A LINE INC ARAGON CONSTRUCTION, INC. ARCHITECTURAL GLASS & ALUMINUM ARCHWAY GLASS ARROW GLASS CO ARTIFICIAL GRASS PROS ASSOCIATED TANK CONSTRUCTORS, ATLAS GLASS CO. INC. B & C PAINTING & DECORATING B & G GLASS, INC. B.T. MANCINI CO., INC. BACA & SONS PAINTING BAGATELOS ARCH GLASS SYSTEMS BASCO DRYWALL & PAINTING CO. 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CNJ ENTERPRISES, INC. COAST COUNTIES GLASS COATING'S UNLIMITED COFFEY BUILDING GROUP INC. COMBOS GLASS, INC. COMMERCE COATING SERVICES, INC COMMERCIAL GLASS & ALUM INC COMPLETE MILLWORK SERVICES, IN COMPONENT WEST, INC. CONCORD DRYWALL, INC CONKLIN BROS S F CONKLIN BROS-SANTA ROSA CONSOLIDATED SPECIALTIES, INC. CONTRACT GLAZIERS, INC. COOL PAINTING COX COMMERCIAL FLOORING INC CREATIVE CEILINGS, INC. CREATIVE FLOOR COVERINGS CREATIVE SHOWER DOOR CROWN CORR, INC. CROWN SHEET METAL & SKYLIGHTS CUSTOM DRYWALL INC CYC COMMERCIAL INTERIORS, INC. D & B PAINTING COMPANY D & C GLASS AND ALUMINUM, INC. D & R GLASS, INC. D C VIENT INC D P R CONSTRUCTION, INC D ZELINSKY & SON INC D&B/JTS PAINTING INC. JV D.S. BAXLEY, INC. DBA DSB+ EAS D2 SQUARED INDUSTRIAL SERVICES DALEYS DRYWALL INC DARDEN PAINTING INC DDPD INC DELTA CITY DRYWALL INC DEPARTMENT OF STATE HOSPITALS DEPT OF GENERAL SERVICES DESIGN WORKSHOPS DEVCO DRYWALL INTERIORS INC. DI INDUSTRIAL COATINGS, INC. DIETLIN PNTG & DEC DISTRICT COUNCIL 16 DIVERSIFIED FLOORING SERV DOLACKI CONSTRUCTION DONALD E. MCNABB CO. DOTTO GLASS INC DOWNEY AND SON DSM CONSTRUCTION, INC. DYNAMIC COATINGS, INC. EAGLE INDUSTRIAL PAINTING, LLC ELADIO R GUTIERREZ ELITE PAINTING & WALLCOVERING, ELLIS FLOORING INC ENCLOS CORP/ HARMON ERIC STARK INTERIORS ESTATE MAINTENANCE SRVC EUREKA FLOOR-TRAINING FUND EVAN PATTERSON CONSTRUCTION EVERGREENE PAINTING STUDIO EXCLUSIVELY DOORS EXPERT DRYWALL SYS INC F D THOMAS INC FAIRMONT HOTEL SAN JOSE FDR DRYWALL, INC. IDENTIFICATION OF RELATED ORGANIZATIONS CONT'D. FDT STRUCTURAL SPECIALTIES, LL FEDOR WALL SYSTEMS, INC. FIELDTURF USA INC FIERRO PAINTING FISHER DESIGN + BUILD, INC. FIX PAINTING CO FLOOR SEAL TECH ATTN:LETICIA FLOOR TECH AMERICA, INC. FLORES DRYWALL INC. FORTSON FLOORS, INC. FRANCISCAN GLASS CO INC FREEMAN CONSTRUCTION COMPANY FREY PLASTERING INC FUENTES PAINTING & DECORATING G & C EQUIPMENT CORPORATION G & S DRYWALL INC GAIDANO & SONS PTG & DECORATIN GEEELY PAINTING & DECORATING, GENESIS FLOORING INC. GEORGE E MASKER INC GIAMPOLINI & COMPANY GILLIG LLC GIROUX GLASS, INC. GLASS & SASH CO GLASS CONCEPTS BY CLINE GLOBAL SCAFFOLD CONSTRUCTION S GOLDEN GATE DRYWALL GOLDEN GATE GLASS & MIRROR CO GOLDEN STATE CONTRACT FLOORING GRAND HYATT GRAND PRIX GLASS GREATER BAY FLOORING INC GRIFFIN PAINTING INC. GUGEL/TODAY PTG & DEC INC H.V. WELKER CO., INC. HALSTEAD DRYWALL INC HANSAN FLOORING HARDMAN GLAZING HAROLD W. THOMPSON HARRISON DRYWALL, INC HARRY L MURPHY HARTLEY CONST INC. HASSON PAINTING CONTRACTORS IN HELOU & SONS CORP. HERLACHE & SONS PAINTING HERRON PAINTING COMPANY HIGHLAND GLASS, LLC HIGHRISE GLASS INC. HOEM & ASSOCIATES, INC. HULSEY CONTRACTING, INC. HUR FLOORING HYATT REGENCY INNOVATIVE CONSTRUCTION INTEGRATED GLASS CONCEPTS, INC INTEGRATED SURFACES INTER CONCEPTS & SUPPLY INTERIOR GLASS SYSTEM IRONWOOD COMMERCIAL BLDRS INC J & J ACOUSTICS INC J & L WALL COVERING INC. J & R THOMPSON, INC J.T. THORPE & SON, INC. JAMES HAGUE WALLCOVERINGS JAMES L. HARRIS PAINTING INC JEFF PAINTING JEFFCO PAINTING & COATING, INC JERRY THOMPSON & SONS INC JMW CARPET & FLOORING INC. JOHN JORY CORPORATION JPK SOLUTIONS, INC. JR CONSTRUCTION KAISER FOUNDATION HOSP CPFC KARSYN CONSTRUCTION INC KBI PAINTING, INC. KEENAN HOPKINS AND SUDER KIM'S FLOORING, INC KINGDOM DRYWALL, INC. KIRK BUILDERS KLW CONSTRUCTION INC. KOVACH BUILDING ENCLOSURES KOVACH ENCLOSURE SYSTEMS, LLC KYA SERVICES, LLC KYO-YA HOTELS & RESORTS, LP LARRY SILVESTRI INC LEDEIT & SONS GLASS INC LEVEL 5, INC. LEVEL IT INSTALLATIONS, LTD. LIBERTY MAINTENANCE, INC. LINCOLN GLASS & MIRROR CO LINOLEUM SALES CO INC LISA DE LA SOL RESTORATION LUCAS PAINTING CO. M & J FLOORCOVERING INC. M & R PAINTING M S F INC MADDEN AND NELSON INC MADSEN BUILDERS MAGNUM DRYWALL INC MAJESTIC CONSTRUCTION MAJESTIC FLOORS, INC. MAR CON COMPANY MASON PAINTING INC MASSIMO RODORIGO DBA NORTH SID MASTER PAINTING & DECORATING MASTERCRAFT FC, LLC MASTERPIECE PAINTING MASTRIA INCORPORATED METRO SERVICE GROUP MGM DRYWALL INC MISSION BAY FLOORING CONTRACTO MISSION GLASS CO MOLINA'S PTG WALLCOVERING MONTICELLI PTG & DEC INC MUEHLHAN CERTIFIED COATINGS MURPHY INDUSTRIAL COATINGS NAHIDI CORPORATION DBA KAISER NATIONAL COATING & LINING COMP NATIONAL GLASS SYSTEMS, INC NATIONAL RETAIL INSTALLATION NC FLOORING GROUP INC NEIGHBORHOOD GLASS NETWORK NELSONS PAINTING NEVELL - STANDARD J.V., LLC NEVELL GROUP INC. 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THE BERG GROUP THE CLIFT ROYAL SONESTA HOTEL THE WESTIN ST FRANCIS THE WRIGHT SOLUTION, LLC. THOMAS INDUSTRIAL COATINGS TISYS CONSTRUCTION TROYER'S DOOR CONTROL, INC. TWIN POST PAINTING & DECORATIN U S GLASS & ALUM INC-NEVADA U-NEAC FRAMING & DRYWALL, INC. UNIFIED FIELD SERVICES CORPORA UNION ROLLING DOOR CO., INC UNITED CALIF ACCESS & SEC SYS UNITED CALIFORNIA GLASS & DOOR UNIVERSAL FLOORING INC USAL PAINTING VALDEZ PAINTING, INC. VALLEY PRECISION GRADING INC. VALLEY WALL SYSTEMS, INC. VALLEY WATERPROOFING INC VALVERDE CO VPM GENERAL BUILDING, LLC W CARTER GLAZING WALTERS & WOLF GLASS COMPANY WALTERS & WOLF INTERIORS WEBCOR CONSTRUCTION, LP WEBCOR CRAFT, LP WEISS SHEET METAL/METCOE SKYLI WEST COAST DRYWALL WEST COAST INDUSTRIAL COATINGS WESTERN ADDITION DRYWALL WESTERN PARTITIONS INC WESTERN TILE & MARBLE INC WESTLAKE VILLAGE APARTMENTS WESTPAC ARCHITECTURAL WESTSIDE DRYWALL, LLC WHITING GLASS WM B SALEH PAINTING WM B SALEH PAINTING INC WOODBRIDGE GLASS, INC. WORK PRESERVATION FUND, INC.