2021-10-07T17:14:40-05:00 2020-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2020-01-01 946171641 STATIONARY ENGINEERS LOCAL 39 HEALTH AND WELFARE PLAN STAT 9252089999 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 BART FLORENCE TRUSTEE 9252089999 2021-10-07 1 BART FLORENCE 999009999 JOSEPH M THIERMANN P01066616 9252779100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z BART FLORENCE 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 107994899 0 X N/A X 1965 CA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS 4 0 127 0 0 0 0 0 99728826 99172723 3021054 4970279 0 0 102749880 104143002 0 0 82120652 81512900 0 0 0 0 0 1779495 1763946 83900147 83276846 18849733 20866156 130987345 158390053 17623419 17476157 113363926 140913896 TO PROVIDE MEDICAL, DENTAL, VISION AND LIFE INSURANCE BENEFITS TO ELIGIBLE PARTICIPANTS OF THE PLAN AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH & WELFARE BENEFITS TO ELIGIBLE 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 19 0 1 127 1 0 0 0 0 0 0 0 0 X 4 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X BENESYS INC 9252089999 7180 KOLL CENTER PARKWAY 200 PLEASANTON CA 94566 X JERRY KALMAR TRUSTEE 1.00 X 0 0 0 BART FLORENCE TRUSTEE 1.00 X 0 0 0 JIM JOHNSON TRUSTEE 1.00 X 0 0 0 DANNY MURTAGH 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 BENESYS 7180 KOLL CENTER PKWY SUITE 200 PLEASANTON CA 94566 THIRD PARTY ADMINISTRATION SERVICES 832376 DELTA DENTAL PO BOX 997330 SACRAMENTO CA 95899 CLAIMS ADMINISTRATION FEES 223727 ANTHEM BLUE CROSS 2121 N CALIFORNIA BLVD 700 WALNUT CREEK CA 94596 CLAIMS ADMINISTRATION FEES 196589 LINDQUIST LLP 5000 EXECUTIVE PKWY 400 SAN RAMON CA 94583 AUDITING SERVICES 158816 WEINBERG ROGER & ROSENFELD 1375 55TH STREET EMERYVILLE CA 94608 LEGAL SERVICES 105197 5 EMPLOYER CONTRIBUTIONS 900099 94993987 94993987 STOP LOSS REIMBURSEMENT 900099 2014945 2014945 PRESCRIPTION DRUG REBATE 900099 1157613 1157613 PARTICIPANT CONTRIBUTIONS 900099 882358 882358 SETTLEMENTS 900099 123820 123820 99172723 4093445 4093445 4728731 3851897 876834 876834 876834 104143002 99172723 0 4970279 81512900 809874 105197 158816 15000 519035 76459 317 79248 83276846 12466292 15009636 496787 5260208 10802506 9012035 47916 43657 107173844 129064517 130987345 158390053 2968987 3409057 14654432 14067100 17623419 17476157 X 0 0 0 0 113363926 140913896 113363926 140913896 130987345 158390053 20866156 6683814 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 14067100 14067100 X 110811816 6683814 6683814 104128002 15000 15000 104143002 83328868 0 83328868 15000 -67022 -52022 83276846 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMEBER 31, 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 PLAN HAS CONTRACTED WITH BENESYS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO EACH OF THE VOTING MEMBERS WITHIN THE ORGANIZATION'S GOVERNING BODY TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT-OF-INTEREST POLICY BY COMPLYING WITH ALL APPLICABLE PROVISIONS OF ERISA, INCLUDING PARTY-IN-INTEREST AND CONFLICT-OF-INTEREST PROVISIONS OF ERISA SECTION 406. ANY CONFLICTS OR POTENTIAL CONFLICTS ARE REPORTABLE TO THE CHAIRMAN OF THE BOARD OF TRUSTEES AND LEGAL COUNSEL FOR THE PLAN. 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 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, BENESYS, INC. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. FORM 990, PART I, LINE 5: THE W-2'S ISSUED BY THE PLAN ARE FOR THE REQUIRED DOMESTIC PARTNER BENEFIT REPORTING. THE PLAN DOES NOT PAY ANY SALARIES OR WAGES. STATIONARY ENGINEERS LOCAL 39 PENSION 7180 KOLL CENTER PKWYSTE 200 PLEASANTON CA 94566 946118939 UNION PENSION PLAN CA 501(A) N/A N/A 0 STATIONARY ENGINEERS LOCAL 39 ANNUITY 7180 KOLL CENTER PKWYSTE 200 PLEASANTON CA 94566 942787714 UNION ANNUITY PLAN CA 501(A) N/A N/A 0 IUOE STATIONARY ENGINEERS LOCAL NO 39 337 VALENCIA STREET SAN FRANCISCO CA 94103 941056580 LOCAL UNION 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 FORM 990, SCHEDULE R, PART VII 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 DECEMBER 31, 2020, THERE ARE APPROXIMATELY 204 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. 11TH & 'L' BUILDING 500 CAPITOL MALL TOWER LLC ABLE ENGINEERING SERVICES ABM ENGINEERING SERVICES ABM ONSITE SERVICES - WEST, INC AEG MANAGEMENT OAKLAND, LLC AHMC SETON MEDICAL CENTER AIRCON ENERGY ALAMEDA HEALTH SYSTEMS ALEUT FACILITY SUPPORT SERVICES LLC ALSCO - NEVADA ALSCO - SAN JOSE ALSCO SACRAMENTO ALSCO SAN FRANCISCO ALTA BATES HOSPITAL AMALGAMATED SERVICE, INC AMB ENGINEERING/INDUSTRY GROUPS AMERICOLD (ENGINEERS) AMERICOLD (WAREHOUSE) AMERICOLD WATSONVILLE ENGINEERS AMI-ACEPEX JV2, LLC ARMARK MANAGEMENT SERVICES LP ARMARK UNIFORM & CAREER APPAREL LLC (OAKLAND) ARMARK UNIFORM & CAREER APPAREL LLC ASCO SERVICE INC BEI HOTEL SF DAVIDSON HOTEL CO LLC DBA BEN FITZGERAL REAL ESTATE SERVICES BENTLY HOLDING CALIFORNIA BERKLEY FARMS, INC BIMBO BAKERIES USA, INC. (SACRAMENTO) BIMBO BAKERIES USA, INC. (SO SF) BOHANNON DEVELOPMENT COMPANY C&W FACILITY SERVICES CACHE CREEK CASINO RESORT CALIFORNIA DAIRIES INC CALIFORNIA PACIFIC MEDICAL CENTER CATHEDRAL HILL PLAZA ASSOCIATES CAZA HIGHGATE HOTELS, LLC CBRE GLOBAL WORKPLACE SOLUTIONS, LLC CBRE GWS, LLC CBRE INC CBRE TECHNICAL SERVICES CHILDREN'S HOSPITAL OAKLAND CHINESE HOSPITAL CIM GROUP CIRCUS-CIRCUS HOTEL AND CASINO/SLOT MECHANICS CITY OF SOUTH SAN FRANCISCO CLAREMONT RESORT INC COLFAX CEMETERY/COUNTY OF PLACER COLLIERS INTERNATIONAL COLLIERS INTERNATIONAL AIRPORT COMMUNTIY HOSPITALS OF CENTRAL CA CROWNE PLAZA SAN FRANCISCO INT'L AIRPORT CUSHMAN & WAKEFIELD DELLEW CORPORATION DELTA BUILDING SERVICES, INC DELTA SOLUTIONS & STRATEGIES DIGNITY HEALTH - SEQUOIA HOSPITAL DIGNITY HEALTH - ST. FRANCIS HOSPITAL DIGNITY HEALTH - ST. MARY'S HOSPITAL DIGNITY HEALTH MERCY GENERAL HOSPITAL DIGNITY HEALTH MERCY HOSPITAL FOLSOM DIGNITY HEALTH MERCY MEDICAL CENTER REDDING DIGNITY HEALTH MERCY SAN JUAN MEDICAL CENTER DIGNITY HEALTH METHODIST HOSPITAL DOMINICAN SANTA CRUZ HOSPITAL DOUBLETREE HOTEL EDEN HOSPITAL EL CAMINO HOSPITAL ENOVITY ENOVITY INC. FAIRMONT HOTEL, SAN JOSE FARRELLY BUILDING SERVICES, INC GEORGE S HALL, INC GLOBAL SPECTRUM, LP GOOD SAMARITAN HOSPITAL GRAND HYATT SAN FRANCISCO GRAND SIERRA RESORT & CASINO GRATON RESORT AND CASION GROWERS ICE COMPANY HONDLERY UNION SQUARE HOTEL HAWTHORNE PLAZA ASSOCIATES, LLC HEARST CORPORATION HERRICK HOSPITAL & HEALTH CENTER HILTON FINANCIAL DISTRICT HILTON HOTEL EMPLOYER, LLC HILTON SAN JOSE HINES HINES AIRBNB HINES INTERESTS LIMITED PARTNERSHIP HINES-FACEBOOK HOLIDAY INN CIVIC CENTER HOLIDAY INN FISHERMAN'S WHARF HOTEL NIKKO SAN FRANCISCO HP HOOD, LLC. / CROWLEY FOODS HYATT REGENCY SACRAMENTO HYATT REGENCY SAN FRANCISCO HYATT REGENCY SF AIRPORT INTERCONTINENTAL SAN FRANCISCO HOTEL INTERSTATE HOTELS, LLC AGENTS FOR TODAY'S HOTEL IUOE LOCAL 39 IUOE LOCAL 39 - SACRAMENTO TRAINING CENTER IUOE LOCAL 39 - TRAINING CENTER IUOE LOCAL 39 - TRAINING CENTER APPRENTICE J & J WORLDWIDE SERVICES J.W. MARRIOTT HOTEL JOHN MUIR MEDICAL CENTER/CONCORD CAMPUS JONES LANG LASALLE JONES LANG LASALLE (WELLS FARGO) JONES LANG LASALLE SERVICES JONES LANG LASALLE SERVICES (SACRAMENTO) JONES LANG LASALLE SERVICES, INC. JONES LANG LASALLE, INC. KABUKI HOTEL KAISER FOUNDATION HOSPITALS KCORP TECHNOLOGY SERVICES, INC. KING RIVER CONSERVATION DISTRICT KINGSBURY GID KURTZERS HEATING & AIR CONDITIONING LANDMARK EXCHANGE MANAGEMENT, INC. LEE'S APPLIANCES, INC. LEGACY MECHANICAL & ENERGY SERVICES, INC MACY'S WEST, INC. MACY'S, INC MARIN GENERAL HOSPITAL MARITIME ACADEMY CALIFORNIA STATE UNIVERSITY MARK HOPKINS HOTEL MARRIOTT OAKLAND CITY CENTER MARRIOTT-FISHERMAN'S WHARF METRO SERVICES GROUP METRO SERVICES GROUP (KAISER CENTER) MILLS-PENINSULA HEALTH SERVICES MJM MANAGEMENT GROUP /DBA/ YERBA BUENA GARDENS NESTLE USA BRANDS COMPANY - MODESTO NEW SOUTH PARKING (FORMERLY AMPCO - SFO) NORTHERN MANAGEMENT SERVICES NOTRE DAME DE NAMUR UNIVERSITY NOVATO COMMUNITY HOSPITAL NRG SERVICES CORPORATION OAKLAND AIRPORT HILTON OLYMPIC CLUB PALACE HOTEL PARAMOUNT PROPERTY COMPANY PARC 55 HOTEL MANAGEMENT, LLC PARK CENTRAL HOTEL SAN FRANCISCO PERALTA COMMUNITY COLLEGE DISTRICT PRIDE INDUSTRIES PULLMAN SAN FRANCISCO BAY HOTEL PUNDIR GROUP QUEEN OF THE VALLEY MEDICAL CENTER REGIONAL MEDICAL CENTER OF SAN JOSE RENO HOUSING AUTHORITY RIU CALIFORNIA LLC SAFEWAY STORES, BAKERY 8122 SAFEWAY STORES, INC. (MILK PLANT) SALINAS VALLEY MEMORIAL HEALTHCARE SYSTEM SAN FRANCISCO 49ERS MANAGEMENT CO, LLC SAN FRANCISCO CONSERVATORY OF MUSIC SAN FRANCISCO HILTON SAN FRANCISCO MARRIOTT MARQUIS SAN FRANCISCO MARRIOTT UNION SQUARE SAN FRANCISCO UNIFIED SCHOOL DISTRICT (SFUSD) SAN JOSE ARENA MANAGEMENT, INC. SAN JOSE ARENA MGMT, INC./SAP CENTER SANTA ROSA MEMORIAL HOSPITAL SODEXH SERVICES WEST (SODEXO) SHASTA LINEN SUPPLY, INC. SHERATON FISHERMAN'S WHARF SHERATON GRAND SACRAMENTO HOTEL SHGSFO MGMT, LLC DBA ALOFT HOTEL SHGSFO MGMT, LLC DBA THE WESTIN SFO AIRPORT HOTEL SIR FRANCIS DRAKE HOTEL SMG / GEORGE MOSCONE CENTER ST REGIS HOTEL ST. JOSEPH'S MEDICAL CENTER ST. ROSE HOSPITAL STANFORD COURT - A RENAISSANCE HOTEL STATE OF CALIFORNIA BARG UNIT 13 SUMMIT MEDICAL CENTER SUN-MAID GROWERS OF CALIFORNIA SUNSET DEVELOPMENT SUTTER ROSEVILLE MEDICAL CENTER SUTTER SANTA ROSA REGIONAL HOSPITAL THE CLANCY, AUTOGRAPH COLLECTION THE CLIFT HOTEL TISHMAN SPEYER TOWNSHIP ENGINEERING SERVICES UNI-KOOL COMPANY (SALINAS) UNIVERSAL PARAGON CORPORATION UNIVERSITY OF SAN FRANCISCO URBAN SERVICES GROUP, INC. VERITY HEALTH SYSTEMS- SETON MED CNTR/COASTSIDE VERITY HEALTH SYSTEMS-SETON MEDICAL CENTER W SAN FRANCISCO HOTEL WASHINGTON HOSPITAL WEINBERG ROGER & ROSENFELD WEST COAST REALTIES, HEARST COMMUNICATIONS, INC. WESTERN CONFERENCE OF OPERATING ENGINEERS WESTIN SAN JOSE WESTIN ST. FRANCIS WMB GENERAL CONTRACTORS WORLEYPARSONS CONSTRUCTORS, INC. YERBA BUENA GARDENS CONSERVANCY ZERO WASTE SOLUTIONS