2020-04-03T14:40:43-05:00 2019-05-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2018-06-01 941235152 LABORERS HEALTH & WELFARE TRUST FUND FOR NORTHERN CALIFORNIA LABO 7078642800 220 CAMPUS LANE FAIRFIELD CA 945341498 BILL KOPONEN TRUSTEE 7078642800 2020-04-03 1 JASMINE S BAKER P01452246 9252779100 66.7.226.66 2020-04-03 12:40:35 PD P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 2018 2020-09-23 17:36:50Z BILL KOPONEN 220 CAMPUS LANE FAIRFIELD CA 945341498 1008002863 0 X N/A X 1953 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 10 0 0 0 0 0 0 0 366699582 380729274 14130916 23725841 20295 155007 380850793 404610122 0 0 310787605 358257543 0 0 0 0 0 17240598 16997825 328028203 375255368 52822590 29354754 334944683 363613686 168942792 178739243 166001891 184874443 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE EMPLOYERS AND THE UNION. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE EMPLOYERS AND THE UNION. 0 0 0 0 0 0 0 0 0 0 1 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 1 176 0 1 0 0 0 0 0 0 0 0 0 X 10 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 X BYRON C LONEY 7078642800 220 CAMPUS LANE FAIRFIELD CA 94534 BILL KOPONEN TRUSTEE 1.00 X 0 0 0 ROBERT CHRISP TRUSTEE - PAST 1.00 X 0 0 0 JERRY OVERAA TRUSTEE 1.00 X 0 0 0 KURT KNIFFIN TRUSTEE 1.00 X 0 0 0 BRIAN GARDNER TRUSTEE 1.00 X 0 0 0 OSCAR DE LA TORRE TRUSTEE 1.00 X 0 0 0 DOYLE RADFORD TRUSTEE 1.00 X 0 0 0 DAVID GORGAS TRUSTEE 1.00 X 0 0 0 FERNANDO ESTRADA TRUSTEE 1.00 X 0 0 0 RAMON HERNANDEZ TRUSTEE 1.00 X 0 0 0 JAMES TROUP 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 LABORERS FUND ADMINISTRATIVE OFFICE OF N 220 CAMPUS LANE FAIRFIELD CA 94534 ADMINISTRATOR 9239009 BLUE CROSS OF CALIFORNIA PO BOX 70000 VAN NUYS CA 914700001 CLAIMS ADMINISTRATOR 3295381 EPLAN SERVICES 4300 KITTREDGE STREET DENVER CO 80239 CLAIMS ADMINISTRATOR 904011 OPTUM RX PO BOX 509075 SAN DIEGO CA 92150 CLAIMS ADMINISTRATOR 659502 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATOR 586681 9 EMPLOYER CONTRIBUTIONS 900099 355575888 355575888 PARTICIPANT CONTRIBUTIONS 900099 14058425 14058425 REBATES & SUBSIDIES 900099 10507474 10507474 COBRA CONTRIBUTIONS 900099 587487 587487 380729274 6787920 6787920 620330662 603392741 16937921 16937921 16937921 SETTLEMENT INCOME 900099 155007 155007 155007 404610122 380884281 0 23725841 358257543 8976592 255464 41500 562859 6824109 184624 79545 4415 13750 AFFORDABLE CARE ACT FEE 48518 DUES & SUBSCRIPTIONS 6125 OTHER 324 375255368 -422025 -614853 45263004 23747309 40826158 40832551 430988 102267 171444152 222120764 77402406 77425648 334944683 363613686 45332792 30309243 123610000 148430000 168942792 178739243 X 0 0 0 0 166001891 184874443 166001891 184874443 334944683 363613686 29354754 -10482202 0 X X 0 1 X 1 0 0 COMMON COLLECTIVE FUNDS 60425648 F 103-12 INVESTMENT ENTITIES 17000000 F 77425648 ACCUMULATED ELIGIBILITY CREDITS 148430000 148430000 X 393633811 -10482202 -10482202 404116013 494109 494109 404610122 367331311 0 367331311 494109 7429948 7924057 375255368 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF MAY 31, 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'S ADMINISTRATOR BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2016. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION 7,429,948. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH THE LABORERS FUNDS ADMINISTRATIVE OFFICE OF NORTHERN CALIFORNIA, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE FORM 990 HAS NOT BEEN PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY BEFORE FILING THE FORM, HOWEVER THE FORM 990 WAS PROVIDED TO THE ADMINISTRATIVE OFFICE FOR REVIEW PRIOR TO FILING THE FORM. COMPLETE COPIES ARE PROVIDED TO THE GOVERNING BODY MEMBERS UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 12 ALTHOUGH THE ORGANIZATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY, THE ADMINISTRATIVE OFFICE DOES HAVE A CONFLICT OF INTEREST POLICY IN PLACE. THE ADMINISTRATIVE OFFICE EMPLOYEES AND THE ADMINISTRATIVE OFFICE BOARD OF DIRECTORS ARE REQUIRED TO ADHERE TO THAT POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C THE BOARD OF TRUSTEES OF THE ORGANIZATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. 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 TRUST OFFICE. FORM 990, PART VI, SECTION B, LINE 13 ALTHOUGH THE ORGANIZATION DOES NOT HAVE A WHISTLEBLOWER POLICY, THE ADMINISTRATIVE OFFICE DOES HAVE A WHISTLEBLOWER POLICY IN PLACE. THE ADMINISTRATIVE OFFICE EMPLOYEES AND THE ADMINISTRATIVE OFFICE BOARD OF DIRECTORS ARE COVERED BY THAT POLICY. LABORERS PENSION TRUST FUND FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 946277608 TO PROVIDE RETIREMENT TO ELIGIBLE PARTICIPANTS 501(A) 0 LABORERS VACATION-HOLIDAY TRUST FUND FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 946092198 TO PROVIDE VACATION AND HOLIDAY BENEFITS TO ELIGIBLE PARTICIPANTS 501(C)(9) 0 LABORERS TRAINING AND RETRAINING TRUST FUND FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 941688279 TO PROVIDE TRAINING SERVICES TO ELIGIBLE PARTICIPANTS 501(C)(3) 0 LABORERS FUND ADMINISTRATIVE OFFICE FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 941688279 TO PROVIDE TRAINING SERVICES TO ELIGIBLE PARTICIPANTS N/A C 0.33000 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 LABORERS FUND ADMINISTRATIVE OFFICE FOR NORTHERN CALIFORNIA P 8976592 BASED ON TIME AND COSTS SPENT. FORM 990, SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYERS AND THEIR DEPENDENTS. AS OF MAY 31, 2019, THERE ARE APPROXIMATELY 1,444 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 (DISREGARD ENTITY, TAX EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PART II THROUGH IV BY FEDERAL CLASSIFICATION. ARGONAUT CONSTRS INC 101 BUILDERS INC 2 S 2 G CONTRACTING INC 3B ENTERPRISES, LLC A & B CONSTRUCTION INC A B M GEOCONSTRUCTORS, INC. 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BOCKMON & WOODY ELECT CO BOEGER ROBERT PLASTERING BOGARD CONSTRUCTION BOHM ENVIRONMENTAL BOLDT COMPANY BOND BLACKTOP INC BORE ONE INC BORTOLUSSI & WATKIN BOSCACCI INC DBA A M P ELECTRI BOSCO CONSTRUCTORS, INC. BOTHMAN ROBERT A CONSTR BOWEN H. A. ELECTRIC INC BOYETT CONSTRUCTION INC BRADCON DBA BRADLEY CONCR BRADLEY W ELECTRIC BRADY COMPANY/CENTRAL CAL BRAHMA INDUSTRIAL SERVICES INC BRANAGH INC BRANNON P CORPORATION BRATTON MASONRY BRAY J L & SON INC BRAYTON C. T. & SONS INC BREAK AWAY CONCRETE CUT BRIDGEWAY CIVIL CONSTRUCTORS BRIGHTVIEW LANDSCAPE DVLPMNT BRINER & SON, INC BROADWAY MECHANICAL CONTR BROCK G & L CONST CO INC BROSAMER & WALL INC BROTHERTON CORP - LEBPCT BROWN MIKE ELECTRIC CO BROWN VANCE INC BRUTOCO ENG & CONST INC BUGLER CONSTRUCTION BULLSEYE BORING BURKE DIVERSIFIED DBA BURKE CO BURKETT'S GUNITE BURNEY WATER DISTRICT BURNS ROBERT CONSTR INC BUSH ENGINEERING INC BZ CONSTRUCTION C & W CONSTR SPECIALTIES C & W TREE & LANDSCAPE C 2 R ENGINEERING C P A DEMOLITION LLC C W FOX CONSTRUCTION INC C W S CONSTRUCTION GROUP INC CA CAISSONS & SHORING INC CABINET BROKERS INSTALLATION CAHILL CONSTR SVCS INC CAHILL CONTRACTORS INC CAHILL CONTRACTORS LLC CAL CORE CAL EMPIRE ENGINEERING INC CAL INC CAL PACIFIC CONSTRUCTION CAL PACIFIC CONSTRUCTORS INC CAL SAFETY INC CAL STATE CONSTRUCTORS IN CAL VALLEY CONST INC-LEBPCT CALCO FENCE CALIF ENG CONTRS INC CALIF TRACK & ENG INC CALIFORNIA BUILDING STRUCTURES CALIFORNIA COMM POOLS INC CALIFORNIA COMMERCIAL FENCE CALIFORNIA COMPACTION CORP CALIFORNIA CUT & CORE INC CALIFORNIA DRILL & BLAST CALIFORNIA DRYWALL CO CALIFORNIA LANDSCAPE & DESIGN CALIFORNIA PAVERS INC CALIFORNIA PROFESSIONAL ENGINE CALIFORNIA SKATE PARKS CALIFORNIA SOLAR INTEGRATORS, CALIFORNIA SPECTRA INSTRMNTN CALIFORNIA TRENCHLESS INC CALIFORNIA UTILITY ENGINEERING FORM 990, SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS:CONT'D CALSTATE PIPELINE INC CAL-TEX MASONRY INC CAL-VET SERVICES INC CAL-WEST CONCRETE CUTTING CAL-WEST LIGHTING & SIGN CAM BUILDING MAINT INC CAMPANELLA CORPORATION CAMPOS GRN VIEW LNDS & TS CAN-AM CONST CLEANUP CANNON CONSTRUCTORS INC CANYON SPRINGS ENTERPRISE CAPAX GROUP INC CAPCON CAPITOL BARRICADE INC CARLSON'S CONSTRUCTION CARNEYS PLASTERING CARONE AND COMPANY CARONE BRUCE GRAD/PAVING CARPENTER GREG CONCR INC CASE PACIFIC COMPANY CASEY-FOGLI CONCRETE CON CASTRO PLUMBING CAZADORO CONSTRUCTION INC CEIEBAS ENTRPRS, DBA SEXYTREES CELIK ENGINEERING CORP CELL-CRETE CORP CEMEX INC CEN-CAL CONSTRUCTION CENTERLINE STRIPING CO CENTRAL COAST FENCE CENTRAL COAST TRAFFIC SAFETY CENTRAL ILLINOIS LABORERS FUND CENTRAL STRIPING SVC INC CENTRAL VALLEY ENVIRONMENTAL CENTRAL VALLEY STRIPING CENTRE POINT RESOURCES CERES ENVIRONMENTAL SVCS CERTIFIEDSAFETY INC CHAMPION CONTRACTORS CHAPIN DON CO INC CHAVARIN PAVING CHICAGO & VICINITY LAB FUNDS CHRISP COMPANY CHRISTIAN BROS LINING CO CIARI STEPHEN PLBG & HTG CIFAC CITY OF SUSANVILLE CITY RISE INC CIVIL ENGINEERING CONST CIVIL SUBSTATIONS INC CLARK CONSTRUCTION GROUP CLARK G R INC CLARK PACIFIC CLAUSS CONSTRUCTION CLEAR CHANNEL OUTDOOR CLEAR CREEK SYSTEMS INC CLEARWATER LANDSCAPE SVCS CLIPPER INTERNATIONAL CMC TRAFFIC CONTROL SPEC CNSB INC COASTAL INTERNATIONAL INC COASTWIDE ENVIRONMENTAL COFFMAN SPECIALTIES INC COLBURN ELECTRIC INC COLEMAN BILL CONCRETE COLLISHAW C SPRINKLERS IN COLORADO TF RECIP COLUMBIA ELECTRIC INC COLUMBIA STONE INC COMMERCIAL INTERIOR BUILDERS COMMERCIAL TREE CARE COMMUNITY PLAYGROUNDS INC COMPASS ENGINEERING CONTR COMPLETE BLDG & OFFICE CL CONCO COMPANIES CONCO-WEST INC CONCRETE DEMO WORKS CONCRETE NORTH INC CONCRETE VALUE CORP CONDON-JOHNSON & ASSOC CON-QUEST CONTRACTORS INC CONSTRUCTION AREA SIGNS CONSTRUCTION INDUSTRY LABORERS CONTI CORPORATION CONTRA COSTA ELECTRIC INC CONTRACT INSTALLATIONS CONTRACTORS RENTAL CORP - LEBP CONTROL SOLUTIONS INC COOK GENERAL ENGINEERING COOPER ENGINEERING INC CORAL CONSTRUCTION CO COREY DELTA CONSTRUCTORS CORNERSTONE MASONRY INC CORPORATE SIGN SYSTEMS COST OF WISCONSIN CO-T CONSTRUCTION, INC. COULTER CONSTRUCTION INC COUNTY OF MODOC-TRIAL CRT COUNTY OF SISKIYOU COZART BROTHERS INC CPM ENVIRONMENTAL CPM ENVIRONMENTAL INC CRATUS INC CREATIVE MASONRY CROWN MASONRY CRUSADER FENCE CO INC CRUX SUBSURFACE INC CUPERTINO ELECTRIC INC CUSTOM SPRAY SYSTEMS INC CVE CONTRACTING GROUP, INC. DB CYCLONE FENCE & IRON D & E CONSTRUCTION INC D & M TRAFFIC SERVICE INC D H SMITH CO INC. D L FALK CONSTRUCTION INC D L R BUILDERS D LINE CONSTRUCTORS INC D M Z TRANSIT A JV D O D CONSTRUCTION D P I INC D P R CONSTRUCTION D S S CO KNIFE RIVER D. H. BLATTNER & SONS INC DALEO, INC. DALEY'S DRYWALL D'ARCY & HARTY CONSTR INC DASILVA UNDERGROUND DAWSON-MAULDIN CONSTRUC DAWSON-MAULDIN LLC DC SOLAR INC DDM UNDERGROUND INC DE HARO RAMIREZ GROUP DE KAY DEMO &CLEARING INC DE SILVA GATES CONSTR DEAN'S CERTIFIED WELDING, INC. DECKER LANDSCAPING INC DEE ERNEST B DEES BURKE ENG CONSTR LLC DEES-HENNESSEY INC DEL MONTE ELECTRIC CO INC DEL SECCO DIAMOND CORE DELTA BAY CONCRETE CUT DELTA BLUEGRASS COMPANY DELTA CONSTRUCTION CO DEMCON STOMPING CO DEMOLITION SRVCS & GRADING INC DEPT OF CORR - REG ACCTG DEPT OF GEN SRVCS RE DETENTION EQUIPMENT SPEC-LEBPC DEVCON CONSTRUCTION INC DIAMOND FENCE COMPANY DIANI A J CONSTRUCTION CO DIANI BUILDING CORP DIGITAL DESIGN COMMNCTNS DIRT DYNASTY INC DISCOVERY HYDROVAC LLC DISNEY CONSTRUCTION INC DIVERSIFIED CONCR CUTTING-LEBP DIVERSIFIED CONSTR INT'L (DCI, DIXON MARINE SERVICE DMZ BUILDERS DN TANKS INC DOCON INC DOLAN CONCRETE CONSTR DOME CONSTRUCTION CORP DORFMEIER MASONRY INC DOYLE'S WORK CO INC DRAGADOS USA INC DRAGADOS-FLATIRON JV DREAMBUILDER DRILL TECH DRILLING/SHOR DRILLING DIVISION OF MOORE TWI DSM CONCRETE INC DUNN'S SAND INC DUNTON CONSTRUCTION CO DURAN & VENABLES INC DURAN CONSTRUCTION GROUP DURANS PAVING RENTAL, INC DUTCH CONTRACTING INC DUTRA CONSTR CO INC DUTRA MATERIALS DWH CREATIVE CONTRACTING DYNAMIC GENERATOR SERVICE INC DYWIDAG-SYSTEMS INTERNATIONAL E & F DEMOLITION E & S MASONRY CORPORATION E M S PLUMBING E. 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ELITE PLASTERING INC EMBARCADERO ENTERPRISES CORP EMERT CONSTRUCTION INC EMMETT'S EXCAVATION INC EMPIRE ENGINEERING & CONS ENG REM RESOURCES GRP INC ERRG ENGELKE CONSTRUCTION INC ENGINEERED SOIL REPAIRS ENHANCED CONCRETE CONSTR ENVIRONMENTAL CONST GROUP ENVIRONMENTAL RECLAMATION LEBP ESQUIVEL GRADING & PAVING EUROPEAN PAV DESIGNS INC EVANS BROTHERS INC EVERGREEN TREE CARE EXARO TECHNOLOGIES CORP EXCEL SITE SERVICES EXPRESS CONCR BRKG & CUT F & H CONSTRUCTION F C B CONSTRUCTION F C S STRIPING SEALING PAVING, F D T STRUCTURAL SPECIALTIES F M K CONSTRUCTION F P BUILDERS F-3 FIREPROOFING INC FANFA INC ENG CONT FARRELL DESIGN-BUILD CO FARWEST SAFETY INC FEDCO SHOTCRETE FENCE CORP INC FENCE MASTERS INC FERGUSON H S CONSTR FERGUSON WELDING SERVICE FERMA CORPORATION FERMIN CONSTRUCTION FERRABEE G CO FERREIRA CONSTRUCTION CO FIDATO FIELD R N CONSTR INC FIGUEROA RAY CONSTRUCTION, INC FISHER CONSTRUCTION GROUP INC FISHER DEVELOPMENT INC FISHER SAND & GRAVEL CO FITZGIBBON MASONRY FITZMAURICE J H FLATIRON WEST INC FLATIRON-KIEWIT JV FLEXGROUND SURFACES INC FLINT BUILDERS INC FLOOR SEAL TECHNOLOGY INC FLORES J CONST CO INC FOCON INC AKA FOCUS FONTENOY ENGINEERING FORCE TRAFFIC CONTROL SVC FORCEFIELD GROUP, INC. 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