2020-10-26T18:48:58-05:00 2019-12-31 450250958 EIDE BAILLY LLP 3130 CROW CANYON PL STE 300 SAN RAMON CA 945831386 990 2019-01-01 946415220 U A LOCAL NO 467 HEALTH & WELFARE TRUST FUND UALO 4082884400 6800 SANTA TERESA BLVD NO 100 SAN JOSE CA 95119 MARK BURRI CHAIRMAN 4082884400 2020-10-26 1 THERESA MONTGOMERY P00232100 9254804000 2020-10-24 99.110.55.147 2020-10-26 18:46:11 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 327E456370A643C83A1BB4325D39191A230D016A 2019 2021-04-22 16:20:28Z MARK BURRI 6800 SANTA TERESA BLVD NO 100 SAN JOSE CA 95119 44047497 0 X N/A X 1952 CA PROVIDE HEALTH AND WELFARE BENEFITS ACCORDING TO COLLECTIVE BARGAINING AGREEMENTS 8 8 46 8 0 0 0 0 31548513 33345904 430592 700264 275253 1329 32254358 34047497 0 0 30191672 31183363 0 0 0 0 0 1096726 1101484 31288398 32284847 965960 1762650 44819630 51270368 16286652 16868067 28532978 34402301 NONE 0 0 TO PROVIDE APPROXIMATELY 1,100 ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS WITH HEALTH AND WELFARE BENEFITS ACCORDING TO COLLECTIVE BARGAINING AGREEMENTS BETWEEN EMPLOYERS AND THE UNION. 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 8 0 1 46 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X UNITED ADMINISTRATIVE SERVICES 4082884400 6800 SANTA TERESA BLVD NO 100 SAN JOSE CA 95119 X MARK BURRI CHAIRMAN 5.00 X X 0 0 0 PETE DUFAULT TRUSTEE 5.00 X 0 0 0 GARY SAUNDERS TRUSTEE 5.00 X 0 0 0 ERIC TASSIO TRUSTEE 5.00 X 0 0 0 DANIEL LARATT TRUSTEE 5.00 X 0 0 0 MICHAEL VLAMING TRUSTEE 5.00 X 0 0 0 KEN WESTPHAL TRUSTEE 5.00 X 0 0 0 MATTHEW LARKIN CO-TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 UNITED ADMINISTRATIVE SERVICES 6800 SANTA TERESA BLVD SAN JOSE CA 95119 ADMINISTRATOR 320188 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATION 122994 BLUE CROSS 2121 N CALIFORNIA BLVD WALNUT CREEK CA 94596 CLAIMS ADMINISTRATION 122855 3 EMPLOYER CONTRIBUTIONS 900099 33345904 33345904 33345904 428821 428821 10271443 10000000 271443 271443 271443 SECURITY INCOME ACCOUNT 900099 1329 1329 1329 34047497 33618676 0 428821 31183363 396926 14063 26781 37532 509510 4174 30622 PRINTING 38118 MISCELLANEOUS 20598 POSTAGE 17279 PCORI FEES 3281 2600 32284847 8903689 10876915 8015850 8300165 3265150 2912533 7960 10221 24397438 28832564 229543 337970 44819630 51270368 2156982 1008384 14129670 15859683 16286652 16868067 X 0 0 0 0 28532978 34402301 28532978 34402301 44819630 51270368 1762650 4106673 0 X X 0 1 X 0 0 0 SELF-FUNDED BENEFIT CLAIMS PAYABLE 3353371 GROUP INSURANCE PREMIUMS PAYABLE 1847976 BANK OF HOURS LIABILITY 4280000 CLAIMS INCURRED BUT NOT REPORTED 1332655 SUPPLEMENTAL EXTENDED RESERVE LIABILITY 3857237 VACATION BENEFITS PAYABLE 1188444 15859683 X 38116638 4106673 4106673 34009965 37532 37532 34047497 30517302 0 30517302 37532 1730013 1767545 32284847 PART X, LINE 2: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED AND INFORMED THE SPONSOR BY A LETTER DATED JUNE 17, 1977, THAT THE PLAN AND RELATED TRUST WERE DESIGNED IN ACCORDANCE WITH THE APPLICABLE REGULATIONS OF THE INTERNAL REVENUE CODE (IRC). SUBSEQUENT TO THE ISSUANCE OF THIS DETERMINATION LETTER, THE PLAN WAS AMENDED. HOWEVER, THE SPONSOR AND PLAN MANAGEMENT BELIEVES THAT THE PLAN IS CURRENTLY DESIGNED AND OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC, AND THE PLAN AND RELATED TRUST CONTINUE TO BE TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) 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 IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 1,730,013. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES TO THE CONTRACT ADMINISTRATOR, UNITED ADMINISTRATIVE SERVICES. FORM 990, PART VI, SECTION B, LINE 11B CHAIR AND CO-CHAIR REVIEW THE FORM FORM 990, PART VI, SECTION B, LINE 12C THE ENTITY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY AT THE TRUST FUND MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE PLAN'S FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR. 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FRANCISCO CA 00009 C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PARTS II, III, AND IV - IDENTIFICATION OF RELATED TAX ORGANIZATIONS IN A MULTIEMPLOYER PLAN, A CONTRIBUTING EMPLOYER IS CONSIDERED A RELATED ORGANIZATION BECAUSE THEY ARE OBLIGATED TO CONTRIBUTE TO THE PLAN PURSUANT TO THE TERMS IN THE COLLECTIVE BARGAINING OR PARTICIPATION AGREEMENT. THE ADMINISTRATIVE OFFICE ONLY MAINTAINS THE DATA NECESSARY TO FULFILL THE OBLIGATION TO CONTRIBUTE, IT DOES NOT MAINTAIN SPECIFIC BUSINESS DATA REGARDING THE EMPLOYERS, SUCH AS ENTITY TYPE OR TAX INFORMATION.