2021-02-09T11:02:02-06:00 2020-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2019-05-01 946284253 JOINT BENEFIT TRUST JOIN 9258837300 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 94568 STACEY CUE TRUSTEE 9258837300 2021-02-09 1 JOSEPH M THIERMANN P01066616 9252779100 2019 2022-09-23 18:48:47Z STACEY CUE 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 94568 115649434 0 X N/A X 1972 CA PROVIDE HEALTH AND WELFARE BENEFITS 7 0 0 0 0 0 0 0 50704251 50673638 647724 1059391 30 56898 51352005 51789927 0 0 48285454 39545947 0 0 0 0 0 5229852 5115898 53515306 44661845 -2163301 7128082 39008879 41768062 11263107 7190582 27745772 34577480 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 HEALTH AND WELFARE BENEFITS PROVIDED UNDER COLLECTIVE BARGAINING FOR 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 1 300 0 1 0 0 0 0 0 0 0 0 0 X 7 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICES & BENEFIT ADMINISTRATORS 9258337300 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 X ASHLEY ALVARADO TRUSTEE 3.00 X 0 0 0 CRESCENCIO DIAZ TRUSTEE 2.50 X 0 0 0 ADAM OCHOA TRUSTEE 2.50 X 0 0 0 JUSTIN MULLINS TRUSTEE 2.50 X 0 0 0 MICHAEL MENDOZA TRUSTEE 2.50 X 0 0 0 STACEY CUE TRUSTEE 3.00 X 0 0 0 ADAM SROUFE TRUSTEE 2.50 X 0 0 0 PABLO BARRERA TRUSTEE - PAST 2.50 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 HEALTH SERVICES & BENEFIT ADMIN 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 ADMINISTRATOR FEES 3110992 BLUE CROSS OF CALIFORNIA DEPARTMENT 5812 LOS ANGELES CA 900745812 PPO NETWORK FEE 700656 HEALTH SERVICES FOUNDATION 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 BENEFIT ADMIN. 281000 THE SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARIAL AND CONSULTING FEES 227618 LINDQUIST LLP 5000 EXECUTIVE PKWY SUITE 400 SAN RAMON CA 94583 AUDIT AND COMPLIANCE TESTING FEES 139730 6 EMPLOYER CONTRIBUTIONS 900099 46768771 46768771 STOP-LOSS RECOVERY 900099 1445032 1445032 PRESCRIPTION REBATE INCOME 900099 1387750 1387750 EMPLOYEE CONTRIBUTIONS 900099 1072085 1072085 50673638 791817 791817 64127081 63859507 267574 267574 267574 OTHER INCOME 900099 56898 56898 56898 51789927 50730536 0 1059391 39545947 3012840 142543 124143 98071 1450171 171191 48478 40487 PCORI TAX 26699 OTHER EXPENSES 1275 44661845 768827 945709 6009699 4927491 53872 74014 31951491 35522848 224990 298000 39008879 41768062 367678 180880 10895429 7009702 11263107 7190582 X 0 0 0 0 27745772 34577480 27745772 34577480 39008879 41768062 7128082 -296374 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 2761702 GROUP INS PREMIUMS PAYABLE 328000 CLAIMS PAYABLE & INCURRED BUT NOT REPORTED 3920000 7009702 X 51395482 -296374 -296374 51691856 98071 98071 51789927 48449501 0 48449501 98071 -3885727 -3787656 44661845 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF APRIL 30, 2020, 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 2017. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH 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 ALL MEMBERS OF THE GOVERNING BODY FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT-OF-INTEREST POLICY COVERS TRUSTEES, OFFICERS AND ALL MANAGEMENT EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF THE FUND. THE POLICY PROVIDES SEVERAL EXAMPLES OF TRANSACTIONS THAT WOULD BE CONSIDERED A CONFLICT OF INTEREST. IT IS ASSUMED THAT THE TRUSTEES, OFFICERS AND MANAGEMENT WILL RECOGNIZE CONFLICTS BASED ON THE EXAMPLES, OR BY ANALOGY WITH THE EXAMPLES, PROVIDED IN THE POLICY. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE FUND MANAGER OR CHAIRMAN. TRANSACTIONS MAY BE UNDERTAKEN ONLY IF THEY ARE FULLY DISCLOSED, THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION, A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS, AND THE FUND MANAGER OR CHAIRMAN HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTERESTS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, THE CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 11A: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED NON-PROFIT ORGANIZATION 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, HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC. FORM 990, PART XII, LINE 2C THE BOARD ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. 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