2017-09-05T14:30:08-05:00 2016-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2016-01-01 946171641 STATIONARY ENGINEERS LOCAL 39 HEALTH AND WELFARE PLAN STAT 9252089999 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 JERRY KALMAR TRUSTEE 9252089999 2017-09-05 1 JOSEPH M THIERMANN P01066616 9252779100 66.7.226.66 2017-09-05 12:29:33 PD P 44F0FEE5B9E9A0A04764C0C4CC9764A73E05E083 6DD8E3D40C39F05221E97E07BD1CB8F36D910CAE 2016 2021-01-29 14:40:06Z JERRY KALMAR 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 82689046 0 X N/A X 1965 CA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS 6 0 0 0 0 0 0 0 77155981 81418566 2682323 1270480 0 0 79838304 82689046 0 0 68540312 68168797 0 0 0 0 0 1684425 1692125 70224737 69860922 9613567 12828124 61372929 74832519 14678005 14061502 46694924 60771017 TO PROVIDE MEDICAL, DENTAL, VISION AND LIFE INSURANCE BENEFITS TO ELIGIBLE MEMBERS OF THE PLAN AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH & 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 0 0 1 0 0 0 0 0 0 0 X 6 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X BENESYS INC 9252089999 7180 KOLL CENTER PARKWAY 200 PLEASANTON CA 94566 X JERRY KALMAR TRUSTEE 1.00 X 0 0 0 BART FLORENCE TRUSTEE 1.00 X 0 0 0 PAUL BENSI TRUSTEE 1.00 X 0 0 0 LYLE SETTER TRUSTEE 1.00 X 0 0 0 DAN MCNULTY TRUSTEE (PAST) 1.00 X 0 0 0 DANNY MURTAGH TRUSTEE 1.00 X 0 0 0 TIMOTHY EGGEN TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 1.00 X 0 1 0 0 1 0 0 0 0 0 BENESYS 7180 KOLL CENTER PKWY SUITE 200 PLEASANTON CA 94566 THIRD PARTY ADMINISTRATION SERVICES 728440 DELTA DENTAL PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS ADMINISTRATION FEES 250305 WEINBERG ROGER & ROSENFELD 1001 MARINA VILLAGE PKWY SUITE 200 ALAMEDA CA 94501 LEGAL SERVICES 194085 ANTHEM BLUE CROSS 2121 N CALIFORNIA BLVD 700 WALNUT CREEK CA 94596 CLAIMS ADMINISTRATION FEES 158286 4 EMPLOYER CONTRIBUTIONS 900099 79696463 79696463 STOP LOSS REIMBURSEMENT 900099 795492 795492 PARTICIPANT CONTRIBUTIONS 900099 544850 544850 PRESCRIPTION DRUG REBATE 900099 330133 330133 OTHER 900099 51628 51628 81418566 1270480 1270480 82689046 81418566 0 1270480 68168797 713698 194085 98111 15000 501388 53738 4220 48534 TRANSITIONAL REINSURANC 63351 69860922 13068295 9281769 2242946 783395 7365412 14091412 38672943 50650942 23333 25001 61372929 74832519 2827633 2267206 8372 0 11842000 11794296 14678005 14061502 X 0 0 0 0 46694924 60771017 46694924 60771017 61372929 74832519 12828124 1247969 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 11794296 11794296 X 83922015 1247969 1247969 82674046 15000 15000 82689046 70444818 0 70444818 15000 -598896 -583896 69860922 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMEBER 31, 2016, 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 IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2013. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH BENESYS, INC. TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO EACH OF THE VOTING MEMBERS WITHIN THE ORGANIZATION'S GOVERNING BODY TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT-OF-INTEREST POLICY BY COMPLYING WITH ALL APPLICABLE PROVISIONS OF ERISA, INCLUDING PARTY-IN-INTEREST AND CONFLICT-OF-INTEREST PROVISIONS OF ERISA SECTION 406. ANY CONFLICTS OR POTENTIAL CONFLICTS ARE REPORTABLE TO THE CHAIRMAN OF THE BOARD OF TRUSTEES AND LEGAL COUNSEL FOR THE PLAN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 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 THIRD-PARTY ADMINISTRATOR, BENESYS, INC. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. STATIONARY ENGINEERS LOCAL 39 PENSION 7180 KOLL CENTER PKWYSTE 200 PLEASANTON CA 94566 946118939 UNION PENSION PLAN CA 501(A) N/A N/A 0 STATIONARY ENGINEERS LOCAL 39 ANNUITY 7180 KOLL CENTER PKWYSTE 200 PLEASANTON CA 94566 942787714 UNION ANNUITY PLAN CA 501(A) N/A N/A 0 IUOE STATIONARY ENGINEERS LOCAL NO 39 337 VALENCIA STREET SAN FRANCISCO CA 94103 941056580 LOCAL UNION CA 501(C)5 N/A N/A 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 DECEMBER 31, 2016, THERE ARE APPROXIMATELY 185 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 (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. 11TH & 'L' BUILDING 500 CAPITOL MALL TOWER LLC ABLE ENGINEERING SERVICES ABM ENGINEERING SERVICES ABM ONSITE SERVICES - WEST, INC. AEG MANAGEMENT OAKLAND, LLC AIR LIQUIDE AMERICA, INC AIRCON ENERGY ALAMEDA HEALTH SYSTEMS ALEUT FACILITY SUPPORT SERVICES LLC ALSCO - NEVADA ALSCO - SAN JOSE ALSCO SACRAMENTO ALSCO SAN FRANCISCO ALTA BATES HOSPITAL AMERICOLD AMERICOLD (ENGINEERS) AMERICOLD (WAREHOUSE) AMERICOLD WATSONVILLE ENGINEERS AMI-ACEPEX JV2, LLC ARAMARK UNIFORM & CAREER APPAREL LLC (OAKLAND) ARAMARK UNIFORM AND CAREER APPAREL LLC ASCO SERVICE INC ASSOC OF SAN JOSE MEDICAL CNTRS (GOOD SAMARITAN) ASSOC OF SAN JOSE MEDICAL CNTRS (REGIONAL MEDICAL) BENTLY HOLDINGS CALIFORNIA BERKELEY FARMS, INC. BIMBO BAKERIES USA, INC. (SACRAMENTO) BIMBO BAKERIES USA, INC. (SO SF) BOHANNON DEVELOPMENT COMPANY C&W FACILITY SERVICES INC. CACHE CREEK CASINO RESORT CALFOX CALIFORNIA DAIRIES INC CALIFORNIA PACIFIC MEDICAL CENTER CATHEDRAL HILL PLAZA ASSOCIATES CBRE GLOBAL WORKPLACE SOLUTIONS, LLC CBRE GWS, LLC CBRE TECHNICAL SERVICES CHILDREN'S HOSPITAL OAKLAND CHINESE HOSPITAL CIM GROUP CIRCUS-CIRCUS HOTEL CASINO/SLOT MECHANICS CLAREMONT RESORT INC COLFAX CEMETERY/COUNTY OF PLACER COLLIERS INTERNATIONAL COMMUNITY HOSPITALS OF CENTRAL CA (FRESNO COMM HOS CROWNE PLAZA SAN FRANCISCO INT'L AIRPORT CUSHMAN & WAKEFIELD DAUGHTERS OF CHARITY - SETON MED CNTR/COASTSIDE DAUGHTERS OF CHARITY - SETON MEDICAL CENTER DELTA BUILDING SERVICES, INC. DELTA SOLUTIONS & STRATEGIES DIGNITY HEALTH - SEQUOIA HOSPITAL DIGNITY HEALTH - ST. FRANCIS HOSPITAL DIGNITY HEALTH - ST. MARY'S HOSPITAL DIGNITY HEALTH METHODIST HOSPITAL DOMINICAN SANTA CRUZ HOSPITAL DOUBLETREE HOTEL EDEN HOSPITAL EL CAMINO HOSPITAL ENOVITY INC. ENOVITY, INC. EQUITY OFFICE PROPERTIES FAIRMONT HOTEL, SAN JOSE FARRELLY BUILDING SERVICES, INC. FRIEL ENERGY SOLUTIONS GEORGE S. HALL, INC. GRAND HYATT SAN FRANCISCO GRAND SIERRA RESORT & CASINO GROWERS ICE COMPANY HANDLERY UNION SQUARE HOTEL HEARST CORPORATION HERRICK HOSPITAL & HEALTH CENTER HILTON FINANCIAL DISTRICT HINES HINES - AIRBNB HINES-FACEBOOK HOLIDAY INN CIVIC CENTER HOLIDAY INN FISHERMAN'S WHARF HOLIDAY INN GOLDEN GATEWAY HOTEL NIKKO SAN FRANCISCO HP HOOD, LLC. / CROWLEY FOODS HYATT REGENCY SACRAMENTO HYATT REGENCY SAN FRANCISCO HYATT REGENCY SF AIRPORT INTERCONTINENTAL SAN FRANCISCO HOTEL IOUE LOCAL 39 ISS FACILITY SERVICES IUOE LOCAL 39 IUOE LOCAL 39 - SACRAMENTO TRAINING CENTER IUOE LOCAL 39 - TRAINING CENTER IUOE LOCAL 39 - TRAINING CENTER APPRENTICE J & J MAINTENANCE, INC. J.W. MARRIOTT HOTEL JOHN MUIR MEDICAL CENTER/CONCORD CAMPUS JONES LANG LASALLE JONES LANG LASALLE SERVICES (SACRAMENTO) JONES LANG LASALLE SERVICES, INC. KABUKI HOTEL KAISER FOUNDATION HOSPITAL KAISER FOUNDATION HOSPITALS KCORP TECHNOLOGY SERVICES, INC. KINGS RIVER CONSERVATION DISTRICT KINGSBURY GID KURTZERS HEATING & AIR CONDITIONING LANDMARK EXCHANGE MANAGEMENT, INC. LEE'S APPLIANCES, INC. LEGACY MECHANICAL & ENERGY SERVICES, INC. MACY'S WEST, INC. MACY'S, INC. MARIN GENERAL HOSPITAL MARINOVICH COLD STORAGE, INC. (ENGINEERS) MARINOVICH COLD STORAGE, INC. (WAREHOUSE) MARK HOPKINS HOTEL MARRIOTT COURTYARD SF DOWNTOWN MARRIOTT OAKLAND CITY CENTER MARRIOTT-FISHERMAN'S WHARF METRO MAINTENANCE MILLS-PENINSULA HEALTH SERVICES MJM MANAGEMENT GROUP /DBA/ YERBA BUENA GARDENS NESTLE USA BRANDS COMPANY - MODESTO NEW SOUTH PARKING (FORMERLY AMPCO - SFO) NORTH TAHOE PUD NORTHERN MANAGEMENT SERVICES NOTRE DAME DE NAMUR UNIVERSITY NOVATO COMMUNITY HOSPITAL OAKLAND AIRPORT HILTON O'CONNOR HOSPITAL/DAUGHTERS OF CHARITY OLYMPIC CLUB, THE PALACE HOTEL PARAGON SERVICES ENGINEERING PARC 55 HOTEL MANAGEMENT, LLC PARK CENTRAL HOTEL SAN FRANCISCO PRIDE INDUSTRIES PULLMAN SAN FRANCISCO BAY RNM PROPERTIES SAFEWAY STORES, BAKERY 8122 SAFEWAY STORES, INC. (MILK PLANT) SAINT LOUISE REGIONAL HOSPITAL/DAUGHTERS OF CHARIT SALINAS VALLEY MEMORIAL HEALTHCARE SYSTEM SAN FRANCISCO 49ERS MANAGEMENT CO, LLC SAN FRANCISCO CONSERVATORY OF MUSIC SAN FRANCISCO HILTON SAN FRANCISCO MARRIOTT MARQUIS SAN FRANCISCO MARRIOTT UNION SQUARE SAN JOSE ARENA MANAGEMENT, INC. SAN JOSE HILTON & TOWERS SANTA CLARA CHAMBER OF COMMERCE SANTA ROSA MEMORIAL HOSPITAL SAPUTO DAIRY FOODS USA, LLC SCANLANKEMPERBARD CO., LLC SHASTA LINEN SUPPLY, INC. SHERATON FISHERMAN'S WHARF SHERATON GRAND SACRAMENTO HOTEL SIR FRANCIS DRAKE HOTEL SMG / GEORGE MOSCONE CENTER ST REGIS HOTEL, THE ST. JOSEPH'S MEDICAL CENTER ST. ROSE HOSPITAL STANFORD COURT - A RENAISSANCE HOTEL SUMMIT MEDICAL CENTER SUN-MAID GROWERS OF CALIFORNIA SUNSET DEVELOPMENT SUTTER ROSEVILLE MEDICAL CENTER SUTTER SANTA ROSA REGIONAL HOSPITAL THE CLIFT HOTEL TISHMAN SPEYER TOWNSHIP ENGINEERING SERVICES UNI-KOOL COMPANY (SALINAS) UNIVERSAL PARAGON CORPORATION UNIVERSITY OF SAN FRANCISCO URBAN SERVICES GROUP, INC. VANBARTON GROUP, LLC W SAN FRANCISCO HOTEL WATERTON ASSOCIATES DBA THE ALOFT HOTEL WATERTON ASSOCIATES DBA THE WESTIN SFO AIRPORT WEINBERG ROGER & ROSENFELD WEST COAST REALTIES, HEARST COMMUNICATIONS, INC. WESTERN CONFERENCE OF OPERATING ENGINEERS WESTIN SAN JOSE WESTIN ST. FRANCIS WMB GENERAL CONTRACTORS WORLEYPARSONS CONSTRUCTORS, INC. ZERO WASTE SOLUTIONS