2020-02-05T13:05:34-06:00 2019-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY 400 SAN RAMON CA 94583 990 2018-05-01 941206350 CALIFORNIA SVC EMPLOYEES HEALTH & WELFARE TRUST FUND CALI 6505707300 1000 MARINA BLVD NO 400 BRISBANE CA 940051841 CHARLIE GILCHRIST TRUSTEE 6505707300 2020-02-05 1 DEBBIE ROESSL DIMERY P01065763 9252779100 66.7.226.66 2020-02-05 11:05:20 PS P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 2018 2020-09-23 17:36:50Z CHARLIE GILCHRIST 1000 MARINA BLVD NO 400 BRISBANE CA 940051841 221450772 0 X N/A X 1951 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 6 0 60 0 0 0 0 0 115497028 120396649 3051628 3316266 0 0 118548656 123712915 0 0 113736961 115110079 853784 899332 0 0 0 2119072 2283504 116709817 118292915 1838839 5420000 145264822 152179225 25911042 24212877 119353780 127966348 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND 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 1 246 0 1 60 1 0 0 0 0 0 0 0 0 X 6 0 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 1 1 0 X NORTHWEST ADMINISTRATORS INC 6505707300 1000 MARINA BLVD STE 400 BRISBANE CA 940051841 X DAVID HUERTA TRUSTEE 0.30 X 0 0 0 CHARLES GILCHRIST TRUSTEE 5.00 X 18000 0 33702 RAY NANN TRUSTEE 5.00 X 18000 0 33702 LARRY T SMITH TRUSTEE 5.00 X 18000 0 33702 MARK SHARWOOD ALTERNATE TRUSTEE 0.50 X 0 0 0 CHRISTOPHER BOUVIER ALTERNATE TRUSTEE 0.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 X 0 0 0 54000 0 101106 0 0 0 0 NORTHWEST ADMINISTRATORS INC 2323 EAST LAKE AVE E SEATTLE WA 98102 FUND ADMINISTRATION 771940 LINDQUIST LLP 5000 EXECUTIVE PARKWAY STE 400 SAN RAMON CA 94583 AUDITING AND ACCOUNTING SERVICES 216722 BUILDING SKILLS PARTNERSHIP 828 W WASHINGTON BLVD LOS ANGELES CA 90015 PROGRAM ACTIVITIES 172620 MCMORGAN COMPANY ONE FRONT ST SUITE 500 SAN FRANCISCO CA 94111 CONSULTING 137739 VISION SERVICE PLAN 101 CALIFORNIA STREET 975 SAN FRANCISCO CA 94111 ADMINISTRATIVE SERVICE 124915 8 EMPLOYER CONTRIBUTIONS 900099 119588803 119588803 EMPLOYEE CONTRIBUTIONS 900099 690744 690744 PRESCRIPTION CLAIMS REBATE 900099 102344 102344 STOP LOSS INCOME 900099 14758 14758 120396649 4074720 4074720 96979403 97737857 -758454 -758454 -758454 123712915 120396649 0 3316266 115110079 160767 466311 108419 111667 52168 802800 235429 235198 183244 420001 219916 25920 2185 16479 130724 OTHER EXPENSE 11608 118292915 646681 541614 16414704 17176596 14287000 14000000 113463209 120072610 453228 388405 145264822 152179225 136604 170647 25774438 24042230 25911042 24212877 X 0 0 0 0 119353780 127966348 119353780 127966348 145264822 152179225 5420000 3192568 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 22735000 CLAIMS PAYABLE AND IBNR 582000 GROUP INSURANCE PREMIUMS PAYABLE 585000 DUE TO BROKER 140230 24042230 X 126722239 3192568 3192568 123529671 183244 183244 123712915 119632671 0 119632671 183244 -1523000 -1339756 118292915 PART X, LINE 2: THE PLAN'S ADMINISTRATORS HAVE ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAVE CONCLUDED THAT AS OF APRIL 30, 2019, 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 2016. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH NORTHWEST ADMINISTRATORS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES REVIEWS AND APPROVES COMPENSATION FOR THE PLAN'S EMPLOYEES BASED ON STAFF CLASSIFICATIONS AND WAGE SCALES ALONG WITH OTHER DATA AVAILABLE. THE COMPENSATION FOR THE TRUSTEES IS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES BASED ON THE AMOUNT OF TIME THE TRUSTEES SPEND PERFORMING THEIR DUTIES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A SOME TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. FOR MORE INFORMATION, CONTACT THE THRID-PARTY ADMINISTRATOR, NORTHWEST ADMINISTRATORS, INC. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDITOR AND FOR SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. FORM 990, PART VI, LINE 2A THE PLAN HAS 8 EMPLOYEES, HOWEVER THE FORM W-3 REPORTED 60. THERE WERE 52 PARTICIPANTS THAT RECEIVED A W-2 FOR IMPUTED INCOME FOR DOMESTIC PARTNER BENEFITS RECEIVED. SERVICE EMPLOYEES INTERNATIONAL UNION LOCAL 1877 828 WEST WASHINGTON BLVD LOS ANGELES CA 90015 770214817 LABOR UNION CA 501(C)(5) N/A SERVICE EMPLOYEES INTERNATIONAL UNION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 APRIL 30, 2019, THERE WERE APPROXIMATELY 82 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISRTRATIVE 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 & A MAINTENANCE ENTERPRISE INC. ABLE BLDG MAINT ABLE SERVICES ABM ADVANCE BLDG MAINT AIR SERV CORP AIRPORT TERMINAL MGMT ALBERTSONS INC ALLIED UBM ALLIED UNIVERSAL APPRENTICE & JOURNEYMAN ARAMARK FACILITY SERV-GALEN CTR AVIATION SAFEGUARDS BLACKSTONE CONSULTING BUNKER HILL TOWER CONDO ASSOC C & W FACILITY SERV CALIFORNIA SERVICE EMPLOYEES TRUST FUND COMMERCIAL CLEANING SYSTEMS DEL MAR THOROUGHBRED CLUB DIVERSE FACILITY SOLUTIONS, INC. BURBANK DMS ENVIRONMENTAL SERVICE SYSTEMS ESC BLDG SVC LLC FLAGSHIP FACILITY SVCS G2 SECURE STAFF GATEWAY GROUP ONE GCA SERVICES GROUP GELSON'S MARKETS GREENBOX SERVICES GUARANTEE PEST CONTROL, INC ILWU HALL,LOCAL #10 INNOVATIVE FACILITY SERVICES JANITORIAL EQUIPMENT SVCS, INC KOHL BLDG MAINT - HOLLYWOOD CTR LA ARENA CO, LLC LA HABRA LEVY PREMIUM FOOD SERV LOCAL 280 PARIMUTUEL EMPLOYEES LOS ANGELES DODGERS MENZIES AVIATION MERCHANTS BLDG MAINT METRO SERV GRP METRO SERV SO MILLENNIUM BILTMORE HOTEL MORRISON HEALTHCARE - BROTMAN MED CTR NATIONAL BUILDING SERVICES LLC NATIONWIDE JANT'L SERV NEXT CENTURY ASSOCIATES, LLC ONE STOP BLDG MAINT-COMMERCE PLAZA PACIFIC PROTECTION SERVICES, INC PARAGON SERVICES JANITORIAL PE FACILITY SOLUTIONS PEERLESS BLDG MAINT PEGASUS BUILDING SERVICES PRIDE INDUSTRIES PROFESSIONAL MAINT SYSTEMS RACE TRACK LOCAL 1877 RACE TRACK LOCAL 280 RALPH'S GROCERY CO. REGENT BEVERLY WILSHIRE HOTEL, INC SANTA FE BUILDING MAINTENANCE SDH SERVICES WEST / SODEXO SEIU LOCAL 121RN SEIU LOCAL 99 SERVI - TEK, INC. SERVICON SYSTEMS INC - MCAA G/F KAISER FAMILY SODEXO - AGOURA HILLS SOMERS BUILDING MAINTENANCE SOS SECURITY LLC STATER BROTHERS MARKET STEAMFITTERS LOCAL UNION #250 SUNRISE FLOOR SYSTEMS - RALPH'S BFTS SUPER A FOODS TOWNSHIP BLDG MAINT UNISERVE PROJECT MANAGEMENT UNITE HERE LOCAL 2 UNITED BLDG SERVICE US METRO GRP VALLEY VIEW CASINO VON'S GROCERY CO WILSHIRE TERRACE APTS WORLD SERV WEST