2016-03-01T12:39:16-06:00 2015-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY 400 SAN RAMON CA 94583 990 2014-05-01 941206350 CALIFORNIA SVC EMPLOYEES HEALTH & WELFARE TRUST FUND CALI 5104334452 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 CHARLIE GILCHRIST TRUSTEE 5104334452 2016-03-01 1 DEBBIE ROESSL DIMERY P01065763 9252779100 2014 2016-08-17 19:52:53Z CHARLIE GILCHRIST 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 119080795 0 X N/A X 1951 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 5 0 28 0 0 0 0 0 98023797 99701534 1866274 3245213 0 0 99890071 102946747 0 0 100907982 100265761 623140 711153 0 0 0 2203538 2084307 103734660 103061221 -3844589 -114474 139269189 141101558 22298563 23713406 116970626 117388152 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 1 229 0 1 28 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 ASSOC THIRD PARTY ADMINISTRATORS 5104334452 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 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 29447 RAY NANN TRUSTEE 5.00 X 18000 0 29447 LARRY T SMITH TRUSTEE 5.00 X 18000 0 29447 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATI 0.00 X 0 0 0 54000 0 88341 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 989 MARKET STREET SUITE 320 SAN FRANCISCO CA 94104 FUND ADMINISTRATION 756842 LINDQUIST LLP 5000 EXECUTIVE PARKWAY STE 400 SAN RAMON CA 94583 AUDITING AND ACCOUNTING SERVICES 248413 THE SEGAL COMPANY 100 MONTGOMERY ST SUITE 500 SAN FRANCISCO CA 94104 CONSULTANT 202359 MCMORGAN & COMPANY 425 MARKET STREET SUITE 1600 SAN FRANCISCO CA 94105 INVESTMENT MANAGER 142988 VISION SERVICE PLAN 101 CALIFORNIA STREET 975 SAN FRANCISCO CA 94111 ADMINISTRATIVE SERVICES 132184 5 EMPLOYER CONTRIBUTIONS 900099 98557083 98557083 EMPLOYEE CONTRIBUTIONS 900099 723728 723728 STOP LOSS INCOME 900099 346651 346651 PERSCRIPTION CLAIMS REBATE 900099 70782 70782 OTHER INCOME 900099 3290 3290 99701534 2046458 2046458 17332803 16134048 1198755 1198755 1198755 102946747 99701534 0 3245213 100265761 147786 347665 60501 105030 50171 762813 110948 203635 204619 416170 162422 25920 1739 17269 129251 PCOR TAX 31192 OTHER EXPENSE 18329 103061221 505299 180179 10037267 11502255 11609833 12070049 79603 76978 116522410 116593027 514777 679070 139269189 141101558 116563 68909 22182000 23644497 22298563 23713406 X 0 0 0 0 116970626 117388152 116970626 117388152 139269189 141101558 -114474 532000 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 21612000 CLAIMS PAYABLE AND IBNR 697000 GROUP INSURANCE PREMIUMS PAYABLE 190000 DUE TO BROKER 1145497 23644497 X 103274128 532000 532000 102742128 204619 204619 102946747 102539602 0 102539602 204619 317000 521619 103061221 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, 2015, 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 2012. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH ASSOCIATED THIRD PARTY ADMINISTRATORS TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. 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-EMEMPT ORGANIZATION. FOR ADDITIONAL INFORMATION, CONTACT THE THIRD-PARTY ADMINISTRATOR, ASSOCIATED THIRD PARTY ADMINISTRATORS. 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, IDENTIFICATIION 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, 2015, THERE WERE APPROXIMATELY 76 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 (DISREGARDING 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 FACILITY SERVICES AVIATION SAFEGUARDS - LAX BLACKSTONE CONSULTING BUNKER HILL TOWER CONDO ASSN CALOP AEROGROUND SERVICES DEL MAR THOROUGHBRED CLUB DIVERSE FACILITY SOLUTIONS, INC. DIVERSIFIED MAINT SVC 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 GUARANTEE PEST CONTROL, INC HEALTH & WELFARE OFFICE STAFF HEALTH & WELFARE TRUSTEES HYATT REGENCY CENTURY PLZ HTL 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 LOCAL 99 LA CITY&CNTY SCHL EES LOS ANGELES DODGERS, INC MERCHANTS BUILDING MAINT METRO SERVICE SOUTH, INC MI FAMILIA VOTA MILLENNIUM BILTMORE HOTEL NATIONAL BLDG SVCS NATIONWIDE JANITORIAL SERVICE 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 SANSTRAND SERVICES SDH SERVICES WEST, LLC SEIU LOCAL 121RN SERVICON SYSTEMS, INC SERVI-TEK, INC. SIGNATURE MAINTENANCE SOMERS BUILDING MAINTENANCE STATER BROS MARKETS STEAMFITTERS LOCAL UNION #250 SUNRISE FLOOR SYSTEMS, LLC SUPER A FOODS TOWNSHIP BUILDING MAINTENANCE UGL UNICCO/DTZ, INC. UNITE HERE LOCAL 2 UNITED BLDG SERVICE/ABLE UNIVERSAL BLDG MAINT US METRO GROUP VALLEY VIEW CASINO VON'S GROCERY COMPANY WILSHIRE TERRACE APTS. WORLD SERVICE WEST - LAX