2019-11-15T14:37:02-06:00 2018-12-31 450250958 EIDE BAILLY LLP 3130 CROW CANYON PL STE 300 SAN RAMON CA 945831386 990 2018-01-01 946415220 U A LOCAL NO 467 HEALTH & WELFARE TRUST FUND UALO 4082884400 6800 SANTA TERESA BLVD NO 100 SAN JOSE CA 95119 TRUSTEE TRUSTEE TRUSTEE 4082884400 2019-11-15 1 TERRI MONTGOMERY P00232100 9254804000 216.147.181.51 2019-11-15 14:36:59 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F52D36390EBCF6BF15030359CEDEDEC3AB6B140A 2018 2020-03-31 21:24:44Z 6800 SANTA TERESA BLVD NO 100 SAN JOSE CA 95119 36254358 0 X N/A X 1952 CA SEE PART III LINE 4A 7 7 37 0 0 0 0 0 26133191 31548513 317767 430592 74222 275253 26525180 32254358 0 0 23773214 30191672 0 0 0 0 0 1023755 1096726 24796969 31288398 1728211 965960 45434178 44819630 16793047 16286652 28641131 28532978 NONE 0 0 TO PROVIDE 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 3 0 37 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X UNITED ADMINISTRATIVE SERVICES 4082884400 6800 SANTA TERESA BLVD NO 100 SAN JOSE CA 95119 X MICHAEL VLAMING TRUSTEE 5.00 X 0 0 0 DANIEL LARATT TRUSTEE 5.00 X 0 0 0 ERIC TASSIO TRUSTEE 5.00 X 0 0 0 GARY SAUNDERS TRUSTEE 5.00 X 0 0 0 MARK BURRI TRUSTEE 5.00 X 0 0 0 PETE DUFAULT TRUSTEE 5.00 X 0 0 0 KEN WESTPHAL 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 293370 BLUE CROSS 2121 N CALIFORNIA BLVD WALNUT CREEK CA 94596 CLAIMS ADMINISTRATION 136910 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATION 106736 3 EMPLOYER CONTRIBUTIONS 900099 31548513 31548513 31548513 430592 430592 4000000 4000000 0 REFUNDED STOP LOSS CLAIMS 900099 229543 229543 MEDICARE D SUBSIDY 900099 42389 42389 SECURITY INCOME ACCOUNT 900099 3321 3321 275253 32254358 31823766 0 430592 30191672 370108 13963 64268 32551 5230 24466 ADMINISTRATION FEES 124857 PRESCRIPTION ADMINISTRA 118263 DELTA DENTAL ADMINISTRA 106736 CONSULTANT 96000 140284 31288398 12488368 8903689 7682713 8015850 2996845 3265150 3502 7960 22195801 24397438 66949 229543 45434178 44819630 3849809 2156982 12943238 14129670 16793047 16286652 X 0 0 0 0 28641131 28532978 28641131 28532978 45434178 44819630 965960 -1074113 0 X X 0 1 X 0 0 0 SELF-FUNDED BENEFIT CLAIMS PAYABLE 2975345 GROUP INSURANCE PREMIUMS PAYABLE 1655942 BANK OF HOURS LIABILITY 4312000 CLAIMS INCURRED BUT NOT REPORTED 1140000 SUPPLEMENTAL EXTENDED RESERVE LIABILITY 2868626 VACATION BENEFITS PAYABLE 1177757 14129670 X 31147694 -1074113 -1074113 32221807 32551 32551 32254358 30069415 0 30069415 32551 1186432 1218983 31288398 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. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 1,186,432. 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. 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. UA LOCAL 467 VACATION TRUST FUND 1120 SOUTH BASCOM AVENUE SAN JOSE CA 95218 776018224 TO PROVIDE VACATION BENEFITS TO ELIGIBLE PARTICIPANTS CA 501(C)(9) N/A 0 UA LOCAL 467 DEFINED CONTRIBUTION PLAN 1120 SOUTH BASCOM AVENUE SAN JOSE CA 95218 776007903 TO PROVIDE ANNUITY BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A N/A 0 UA LOCAL 467 DEFINED BENEFIT PLAN 1120 SOUTH BASCOM AVENUE SAN JOSE CA 95218 942353807 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A 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.