2015-08-12T14:34:52-05:00 2014-09-30 954354850 PKF 2020 CAMINO DEL RIO N 500 SAN DIEGO CA 92108 990 2013-10-01 956035916 SAN DIEGO ELECTRICAL HEALTH AND WELFARE SAND 8585696322 PO BOX 231219 SAN DIEGO CA 921931219 ANDY BERG TRUSTEE 8585696322 2015-08-12 1 CURT J WELKER P00399137 6192381040 2013 2016-02-25 16:41:14Z PO BOX 231219 SAN DIEGO CA 921931219 67975796 0 X N/A X 1954 CA TO PROVIDE MEDICAL, DENTAL, VISION AND LIFE INSURANCE BENEFITS TO THE PARTICIPANTS. 10 10 14 0 0 0 0 0 28134924 28328990 578447 645004 7639 10520 28721010 28984514 0 0 21924971 26396483 0 0 0 0 0 2415244 2808622 24340215 29205105 4380795 -220591 23212496 21925907 16422287 15488481 6790209 6437426 TO PROVIDE MEDICAL, DENTAL AND VISION BENEFITS FOR PARTICIPANTS. 0 0 29205105 TO PROVIDE MEDICAL, DENTAL, VISION CARE, AND LIFE INSURANCE BENEFITS, PREMIUMS AND ADMINISTRATION TO PARTICIPANTS. 29205105 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 1 193 0 14 1 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 0 0 CA X KEN STUART 8585696322 4545 VIEWRIDGE AVE STE 110 SAN DIEGO CA 921231688 X BRUCE BAILEY TRUSTEE 1.00 X 0 0 0 JOHNNY SIMPSON TRUSTEE 1.00 X 0 0 0 PHIL PETERSEN TRUSTEE 1.00 X 0 0 0 ANDY BERG TRUSTEE 1.00 X 0 0 0 TERRALYN HARTMAN TRUSTEE 1.00 X 0 0 0 DAVID TAYLOR TRUSTEE 1.00 X 0 0 0 TED BAKER TRUSTEE 1.00 X 0 0 0 ROBERT DAVIES JR TRUSTEE 1.00 X 0 0 0 KEVIN GORMAN TRUSTEE 1.00 X 0 0 0 JOEL BASORE TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 SAN DIEGO ELECTRICAL IND ADMIN PO BOX 231219 SAN DIEGO CA 921931219 ADMINISTRATION SERVICES 1224704 BLUE CROSS 591 CAMINO DE LA REINA SAN DIEGO CA 921083182 CLAIMS ADMINISTRATION 500389 DELTA DENTAL 1450 FRAZEE ROAD SAN DIEGO CA 921084341 CLAIMS ADMINISTRATION 226413 TC3 HEALTH CLAIMS 1901 E ALTON AVE SUITE 100 SANTA ANA CA 92705 CLAIMS ADMINISTRATION 167812 HORIZON ACTUARAIL SERVICES LLC PO BOX 890679 CHARLOTTE NC 282890679 ACTUARIAL SERVICES 116954 5 EMPLOYERS CONTRIBUTION 900099 26674794 26674794 EMPLOYEE CONTRIBUTIONS 900099 1654196 1654196 28328990 687292 687292 38948994 38991282 -42288 -42288 -42288 LIQUIDATED DAMAGES 900099 8012 8012 MISCELLANEOUS INCOME 900099 2508 2508 10520 28984514 28297222 0 687292 26396483 95767 15067 178604 37872 23614 18511 3478 34281 ADMINISTRATIVE OFFICE E 1224712 BLUE CROSS PPO FEES 500389 DELTA DENTAL PLAN ADMIN 226413 HEALTH CLAIMS EDIT EXPE 167812 282102 29205105 269231 198371 3315918 3588194 6891632 4429309 12735715 13708191 0 1842 23212496 21925907 497884 625 15924403 15487856 16422287 15488481 X 0 0 0 0 6790209 6437426 6790209 6437426 23212496 21925907 -220591 -132192 0 X 0 1 X 1 0 0 CLAIMS PAYABLE 814256 CLAIMS INCURRED BUT NOT REPORTED 3425000 CONTINUATION OF BENEFITS 11248600 15487856 X 28852322 -132192 -132192 28984514 0 28984514 29641652 436547 436547 29205105 0 29205105 PART X, LINE 2: THE TRUST IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)9 OF THE INTERNAL REVENUE CODE (IRC), AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE IRS, AND THE PLAN ADMINISTRATOR BELIEVES THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2014 AND 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2009. PART XII, LINE 2D - OTHER ADJUSTMENTS: DECREASE IN HEALTH CLAIMS PAYABLE 64,217. INCREASE IN HEALTH CLAIMS INCURRED BUT NOT REPORTED -183,800. DECREASE IN FUTURE BENEFITS OF PARTICIPANTS' ACCUMULATED ELIGIBILITY 556,130. FORM 990, PART VI, SECTION A, LINE 8B THE GOVERNING BODY DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED BY THE PLAN ADMINISTRATOR FOR ACCURACY AND THEN FILED AND SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY, AND ARE REQUIRED TO NOTIFY THE TRUST OF ANY CHANGES IN THEIR INTERESTS THAT CAN GIVE RISE TO CONFLICTS. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE ON FILE AT THE TRUST OFFICE AND ARE AVAILABLE ON REQUEST. NECA-IBEW DRUG FREE WORKFORCE PROGRAM TRUST PO BOX 231219 SAN DIEGO CA 921931219 260086997 DRUG FREE WORKFORCE CA 501(C)(9) 0 SAN DIEGO ELECTRICAL PENSION TRUST PO BOX 231219 SAN DIEGO CA 921931219 956101801 PENSION PLAN CA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0