2017-02-27T12:48:16-06:00 2016-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY 400 SAN RAMON CA 94583 990 2015-05-01 941206350 CALIFORNIA SVC EMPLOYEES HEALTH & WELFARE TRUST FUND CALI 6505707300 1000 MARINA BLVD NO 400 BRISBANE CA 940051841 CHARLIE GILCHRIST TRUSTEE 6505707300 2017-02-27 1 DEBBIE ROESSL DIMERY P01065763 9252779100 2015 2021-01-29 14:40:06Z X CHARLIE GILCHRIST 1000 MARINA BLVD NO 400 BRISBANE CA 940051841 122258973 0 X N/A X 1951 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 5 0 36 0 0 0 0 0 99701534 104036223 3245213 2049935 0 0 102946747 106086158 0 0 100265761 104803256 711153 691878 0 0 0 2084307 2229024 103061221 107724158 -114474 -1638000 141101558 135339480 23713406 23440681 117388152 111898799 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 1 226 0 1 36 1 0 0 0 0 0 0 X 5 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 STILWELL ALTERNATE TRUSTEE 0.50 X 0 0 0 DAVID HUERTA TRUSTEE 0.30 X 0 0 0 CHARLES GILCHRIST TRUSTEE 5.00 X 18000 0 30479 RAY NANN TRUSTEE 5.00 X 18000 0 30479 LARRY T SMITH TRUSTEE 5.00 X 18000 0 30479 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 X 0 0 0 54000 0 91437 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 989 MARKET STREET SUITE 320 SAN FRANCISCO CA 94104 FUND ADMINISTRATION 818378 MCMORGAN & COMPANY 425 MARKET STREET SUITE 1600 SAN FRANCISCO CA 94105 INVESTMENT MANAGER 147576 BUILDING SKILLS PARTNERSHIP 828 W WASHINGTON BLVD LOS ANGELES CA 90015 PROGRAM ACTIVITIES 122000 LINDQUIST LLP 5000 EXECUTIVE PARKWAY STE 400 SAN RAMON CA 94583 AUDITING AND ACCOUNTING SERVICES 115497 VISION SERVICE PLAN 101 CALIFORNIA STREET 975 SAN FRANCISCO CA 94111 ADMINISTRATIVE SERVICES 107969 6 EMPLOYER CONTRIBUTIONS 900099 102450350 102450350 EMPLOYEE CONTRIBUTIONS 900099 803419 803419 STOP LOSS INCOME 900099 694450 694450 PRESCRIPTION CLAIMS REBATE 900099 85802 85802 OTHER INCOME 900099 2202 2202 104036223 1995447 1995447 16227303 16172815 54488 54488 54488 106086158 104036223 0 2049935 104803256 142572 351685 66989 81413 49219 823833 122856 160332 209068 417722 131742 25920 1694 22750 203863 PCOR TAX 68427 OTHER EXPENSE 40817 107724158 180179 367862 11502255 3554487 12070049 11639619 76978 0 116593027 118648816 679070 1128696 141101558 135339480 68909 178726 23644497 23261955 23713406 23440681 X 0 0 0 0 117388152 111898799 117388152 111898799 141101558 135339480 -1638000 -3851353 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 21824000 CLAIMS PAYABLE AND IBNR 596000 GROUP INSURANCE PREMIUMS PAYABLE 150000 DUE TO BROKER 691955 23261955 X 102025737 -3851353 -3851353 105877090 209068 209068 106086158 107444090 0 107444090 209068 71000 280068 107724158 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, 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 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 DURING THE FISCAL YEAR ENDED APRIL 30, 2016, THE ORGANIZATION HAS CONTRACTED WITH ASSOCIATED THIRD PARTY ADMINISTRATORS TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. SUBSEQUENT TO YEAR END, THE PLAN HAS CONTRACTED WITH NORTHWEST ADMINISTRATORS, INC. TO PROVIDE ADMINISTRATIVE SERVICES. FORM 990, PART VI, SECTION B, LINE 11 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 THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. FOR ADDITIONAL INFORMATION, CONTACT THE THIRD-PARTY ADMINISTRATOR, NORTHWEST ADMINISTRATORS, INC. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND FOR SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. 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, 2016, THERE WERE APPROXIMATELY 82 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 ADMINSITRATIVE 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 CO ABM ADVANCE BLDG MAINT AEROPORT SERVICES, INC. AIR SERV CORPORATION ALBERTSON'S INC-DOWNEY APPRENTICE & JOURNEYMAN ARAMARK - GALEN CENTER ARAMARK FACILITY SERVICES AVIATION SAFEGUARDS - LAX BLACKSTONE CONSULTING BUNKER HILL TOWER CONDO ASSN CALOP AEROGROUND SERVICES DEL MAR THOROUGHBRED CLUB DIVERSE FACILITY SOLUTIONS, INC. DMS - TEMP EMPLOYEES ACCT ENVIRONMENTAL SERVICE SYSTEMS ESC BUILDING SERVICES F E CAMPBELL/CENTURY DENTAL PL FACILITIES SUPPORT SERVICES FACILITY CLEANING INTERNATIONAL FLAGSHIP FACILITY SVCS, INC. G2 SECURE STAFF - LAX GATEWAY GROUP ONE GCA SERVICES GROUP CO. GELSON'S MARKETS GREENBOX SERVICES GUARANTEE PEST CONTROL, INC HEALTH & WELFARE OFFICE STAFF HEALTH & WELFARE TRUSTEES ILWU HALL,LOCAL #10 INNOVATIVE JANITORIAL SERVICE JANITORIAL EQUIPMENT SVCS, INC JMS/PARAMOUNT KLEENHOUSE BUILDING MAINTENANCE KOHL BUILDING MAINTENANCE L A ARENA CO, LLC LA HABRA 300 BOWL LOCAL 280 PARIMUTUEL EMPLOYEES LOS ANGELES DODGERS, INC MENZIES AVIATION MERCHANTS BUILDING MAINT METRO SERVICE SOUTH, INC MI FAMILIA VOTA MILLENNIUM BILTMORE HOTEL MORRISON HEALTHCARE - KAISER MOREN MORRISON HEALTHCARE - MLK HOSPITAL NATIONAL BLDG SVCS NATIONWIDE JANITORIAL SERVICE NEXT CENTURY ASSOCIATES, LLC ONE STOP BUILDING MAINT. PACIFIC BUILDING CARE PARAGON SERVICES JANITORIAL PEERLESS BLDG MAINT PEGASUS BUILDING SERVICES PROFESSIONAL MAINTENANCE SYSTEMS RACE TRACK L-1877 RALPH'S GROCERY CO. REGENT BEVERLY WILSHIRE HOTEL, INC SDH SERVICES WEST, LLC SEIU LOCAL 121RN SEIU LOCAL 99 SERVICON SYSTEMS, INC SERVI-TEK, INC. SIGNATURE MAINTENANCE SODEXO - HEADQUARTERS SOMERS BUILDING MAINTENANCE STATER BROS MARKETS STEAMFITTERS LOCAL UNION #250 SUNRISE FLOOR SYSTEMS, LLC SUPER A FOODS TOWNSHIP BUILDING MAINTENANCE UGL UNICCO/DTZ, INC. UNISERVE PROJECT MANAGEMENT UNITE HERE LOCAL 2 UNIVERSAL BLDG MAINT US METRO GROUP VALLEY VIEW CASINO VON'S GROCERY COMPANY WILSHIRE TERRACE APTS. WORLD SERVICE WEST - LAX