2019-07-15T10:53:25-05:00 2018-08-31 952648289 VAVRINEK TRINE DAY & CO LLP 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2017-09-01 941234856 CARPENTERS HEALTH AND WELFARE TRUST FUND FOR NORTHERN CALIFORNIA CARP 5106330333 265 HEGENBERGER ROAD NO 100 OAKLAND CA 94621 TRUSTEE TRUSTEE SECRETARY 5106330333 2019-07-15 1 MELISSA EVJENTH P01781096 9094664410 174.222.153.211 2019-07-15 10:40:16 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 017B807396221ABF991BD2C11E815DCCEE88D7D2 2017 2019-02-21 02:37:17Z 265 HEGENBERGER ROAD NO 100 OAKLAND CA 94621 1531410374 0 X N/A X 1953 CA SEE PART III LINE 4A 13 13 0 0 0 0 0 0 440601539 490550861 9747498 15348380 15924565 11949681 466273602 517848922 0 0 422663691 466106997 0 0 0 0 0 13894428 14840387 436558119 480947384 29715483 36901538 606541470 664262908 285258508 291888202 321282962 372374706 NONE 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN 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 1 554 0 976 1 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 1 1 0 0 0 X CARPENTERS ADMINISTRATIVE OFFICE 5106330333 265 HEGENBERGER ROAD SUITE 100 OAKLAND CA 94621 X TIMOTHY LIPSCOMB TRUSTEE 5.00 X 0 0 0 RANDY JENCO TRUSTEE 5.00 X 0 0 0 ROY VAN PELT TRUSTEE 5.00 X 0 0 0 FRANK CRIM TRUSTEE 5.00 X 0 0 0 MIKE MENCARINI TRUSTEE 5.00 X 0 0 0 ROBERT ALVARADO TRUSTEE 5.00 X 0 0 0 WILLIAM FEYLING TRUSTEE 5.00 X 0 0 0 TOM MATTIS TRUSTEE 5.00 X 0 0 0 CURTIS KELLY TRUSTEE 5.00 X 0 0 0 CHUCK PALLEY TRUSTEE 5.00 X 0 0 0 DON DOLLY TRUSTEE 5.00 X 0 0 0 AUGIE BELTRAN TRUSTEE 5.00 X 0 0 0 LARRY NIBBI TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 CARPENTER FUNDS ADMINISTRATIVE OFFICE OF 265 HEGENBERGER RD SUITE 100 OAKLAND CA 94621 ADMINISTRATION 6114974 BLUE CROSS OF CALIFORNIA 21555 OXNARD ST WOODLAND HILLS CA 91367 BENEFITS ADMINISTRATOR 2974517 DELTA DENTAL 100 1ST STREET 12TH FLOOR SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATION 1364040 HSTECHNOLOGY 23382 MILL CREEK DR SUITE 200 LAGUNA HILLS CA 92653 BENEFITS ADMINISTRATOR 835883 MEDCO HEALTH SOLUTION 100 PARSONS POND DRIVE FRANKLIN LAKES NJ 07417 BENEFITS ADMINISTRATOR 647983 13 EMPLOYER CONTRIBUTIONS 900099 466516991 466516991 EMPLOYEE CONTRIBUTIONS 900099 24033870 24033870 490550861 8987453 8987453 1019922379 1013561452 6360927 6360927 6360927 REBATES AND REFUNDS 900099 11183807 11183807 OTHER INCOME 900099 728712 728712 LIQUIDATED DAMAGES 900099 37162 37162 11949681 517848922 508861469 0 8987453 466106997 12068906 213235 40779 1518182 264982 336863 42512 115014 OUTSIDE SERVICES 125362 BANKING EXPENSE 61332 PATIENT CARE OUTCOMERES 48441 MISCELLANEOUS 4779 480947384 1225786 439749 108279814 51772097 49343719 51171557 370904 143610 227401083 265983141 215156054 290072718 4764110 4680036 606541470 664262908 305348 628128 284953160 291260074 285258508 291888202 X 0 0 0 0 321282962 372374706 321282962 372374706 606541470 664262908 36901538 14190206 0 X X 0 1 X 1 0 0 REAL ESTATE FUND 91124536 F LIMITED PARTNERSHIP 198948182 F 290072718 PREMIUMS PAYABLE 45916656 CLAIMS PAYABLE AND IBNR 58642263 FUTURE BENEFIT LIABILITY 177600000 RETIREE REFUND PAYABLE 7298000 DUE TO BROKER 1801117 DUE TO OTHER TRUST FUNDS 2038 291260074 X 532039128 14190206 14190206 517848922 0 517848922 480947384 0 480947384 0 480947384 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE TRUST ADMINISTRATOR BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. INFORMATIONAL TAX RETURNS, FOR TAX YEARS FOR WHICH THE APPLICABLE STATUTES OF LIMITATIONS HAVE NOT EXPIRED, ARE SUBJECT TO EXAMINATION BY AUTHORITIES. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES TO THE ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY SUBCOMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES HAVE DESIGNATED THE ADMINISTRATOR TO REVIEW THE FORM 990 PRIOR TO SIGNING AND FILING. FORM 990, PART VI, SECTION B, LINE 12 IN CONNECTION WITH ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST, A TRUSTEE SHOULD DISCLOSE TO ALL OTHER TRUSTEES AND FUND COUNSEL THE EXISTENCE AND NATURE OF THE FINANCIAL INTEREST OR BENEFIT INVOLVED INCLUDING DISCLOSURE OF ALL MATERIAL FACTS ATTENDANT TO THE TRANSACTION. 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 XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT AUDITOR. CARPENTERS PENSION TRUST FUND FOR NORTHERN CALIFORNIA 265 HEGENBERGER RD OAKLAND CA 94621 946050970 TO PROVIDE PENSION BENEFITS FOR ELIGIBLE PARTICIPANTS CA N/A 0 CARPENTERS ANNUITY TRUST FUND FOR NORTHERN CALIFORNIA 265 HEGENBERGER RD OAKLAND CA 94621 946534591 TO PROVIDE AND MAINTAIN AN ANNUITY FUND FOR ELIGIBLE PARTICIPANTS CA N/A 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.