2015-10-26T15:38:06-05:00 2014-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2014-01-01 946171641 STATIONARY ENGINEERS LOCAL 39 HEALTH AND WELFARE PLAN STAT 9252089999 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 PAUL BENSI TRUSTEE 9252089999 2015-10-26 1 JOSEPH M THIERMANN P01066616 9252779100 2014 2016-02-25 16:41:14Z PAUL BENSI 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 85934113 0 X N/A X 1965 CA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS 6 0 0 0 0 0 0 0 64302305 73258039 2535378 1654866 0 0 66837683 74912905 0 0 60644536 67518229 0 0 0 0 0 1388171 1518851 62032707 69037080 4804976 5875825 47300854 53415655 13162879 13380772 34137975 40034883 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 9 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 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 1.00 X 0 0 0 DANNY MURTAGH TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 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 678957 DELTA DENTAL PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS ADMINISTRATION FEES 261707 ANTHEM BLUE CROSS 2121 N CALIFORNIA BLVD 700 WALNUT CREEK CA 94596 CLAIMS ADMINISTRATION FEES 126299 WEINBERG ROGER & ROSENFELD 1001 MARINA VILLAGE PKWY SUITE 200 ALAMEDA CA 94501 LEGAL SERVICES 123576 4 EMPLOYER CONTRIBUTIONS 900099 71885068 71885068 PARTICIPANT CONTRIBUTIONS 900099 806575 806575 SETTLEMENTS 900099 224850 224850 STOP LOSS REIMBURSEMENT 900099 223837 223837 PRESCRIPTION DRUG REBATE 900099 117709 117709 73258039 921362 921362 11754712 11021208 733504 733504 733504 74912905 73258039 0 1654866 67518229 656776 123573 90033 15000 509931 81232 9373 32933 69037080 5915232 4012781 1602850 2244154 6358052 12698615 33408294 34442939 16426 17166 47300854 53415655 2113832 1800323 91047 38449 10958000 11542000 13162879 13380772 X 0 0 0 0 34137975 40034883 34137975 40034883 47300854 53415655 5875825 21083 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 11542000 11542000 X 74918988 21083 21083 74897905 15000 15000 74912905 68754432 0 68754432 15000 267648 282648 69037080 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, 2014, 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 EXAMINATION FOR THE FISCAL YEARS PRIOR TO 2011. 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 11 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 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. 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-EXEMPST ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, BENESYS, INC. STATIONARY ENGINEERS LOCAL 39 PENSION 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 946118939 UNION PENSION PLAN CA 501(A) N/A N/A 0 STATIONARY ENGINEERS LOCAL 39 ANNUITY 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 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, PART VII, SUPPLEMENTAL INFORMATION: 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, 2014 THERE ARE APPROXIMATELY 148 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 ABM ENGINEERING SERVICES AEG MANAGEMENT OAKLAND, LLC AIRCON ENERGY ALEUT FACILITY SUPPORT SERVICES LLC ALSCO - SAN JOSE ALSCO SAN FRANCISCO ALTA BATES HOSPITAL AMI-ACEPEX JV2, LLC ASCO SERVICE INC AT YOUR SERVICE HEATING & COOLING, LLC B&W CONTRACT SERVICES INC BENTLY HOLDINGS CALIFORNIA BERKELEY FARMS, INC. BIMBO BAKERIES USA, INC. (FRESNO) BOHANNON DEVELOPMENT COMPANY BRANDYWINE REALTY TRUST CACHE CREEK CASINO RESORT CALFOX CALIFORNIA DAIRIES INC CALIFORNIA PACIFIC MEDICAL CENTER CALIFORNIA SHELLFISH COMPANY CATHEDRAL HILL PLAZA ASSOCIATES CBRE TECHNICAL SERVICES CHINESE HOSPITAL CIM GROUP CITY OF COLFAX CLAREMONT RESORT INC CLIFT HOTEL, THE COLFAX CEMETERY/COUNTY OF PLACER COLLIERS INTERNATIONAL COLLIERS INTERNATIONAL COMPLETE BUILDING SERVICES CROWNE PLAZA SAN FRANCISCO INT'L AIRPORT CUSHMAN AND WAKEFIELD DAUGHTERS OF CHARITY - SETON MEDICAL CENTER DIGNITY HEALTH - SEQUOIA HOSPITAL DIGNITY HEALTH - ST. FRANCIS HOSPITAL DIGNITY HEALTH - ST. MARY'S HOSPITAL DINAPOLI PROPERTY MANAGEMENT CO. DOCTORS MEDICAL CENTER SAN PABLO DOUBLETREE HOTEL DTZ INC., A UGL COMPANY ENOVITY INC. EQUITY OFFICE PROPERTIES FAIRMONT HOTEL, SAN JOSE FOUR SEASONS HOTEL, SF GEORGE S. HALL, INC. GRAND HYATT SAN FRANCISCO GROWERS ICE COMPANY HANDLERY UNION SQUARE HOTEL HEARST CORPORATION HERRICK HOSPITAL & HEALTH CENTER HILTON FINANCIAL DISTRICT HINES HINES 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 ISS FACILITY SERVICES IUOE LOCAL 39 J.W. MARRIOTT HOTEL JOHN MUIR MEDICAL CENTER/CONCORD CAMPUS JOHNSON CONTROLS GWS, LLC JONES LANG LASALLE JONES LANG LASALLE SERVICES (SACRAMENTO) JONES LANG LASALLE SERVICES (SACRAMENTO) JONES LANG LASALLE SERVICES, INC. KABUKI HOTEL KCORP TECHNOLOGY SERVICES, INC. KINGS ARENA LIMITED PARTNERSHIP, LP KINGSBURY GID KURTZERS HEATING & AIR CONDITIONING LANDMARK EXCHANGE MANAGEMENT, INC. LEE'S APPLIANCES, INC. LEGACY MECHANICAL & ENERGY SERVICES, INC. LEO EPP COMPANY MARK HOPKINS HOTEL MARRIOTT COURTYARD SF DOWNTOWN MARRIOTT OAKLAND CITY CENTER MARRIOTT-FISHERMAN'S WHARF METRO MAINTENANCE MJM MANAGEMENT GROUP /DBA/ YERBA BUENA GARDENS NEW SOUTH PARKING (FORMERLY AMPCO - SFO) NORTH TAHOE PUD NORTHERN MANAGEMENT SERVICES NOTRE DAME DE NAMUR UNIVERSITY 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 RELIABLE BUILDING MAINTENANCE RNM PROPERTIES ROCKEFELLER GROUP INTERNATIONAL INC. ROUND HILL GENERAL SAFEWAY STORES, BAKERY 8122 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 SHASTA LINEN SUPPLY, INC. SHERATON FISHERMAN'S WHARF SHERATON GRAND SACRAMENTO HOTEL SIR FRANCIS DRAKE HOTEL SMG / GEORGE MOSCONE CENTER SMS-VEF IV, LLC SOFITEL HOTEL, SF BAY ST REGIS HOTEL, THE ST. JOSEPH'S MEDICAL CENTER STANFORD COURT - A RENAISSANCE HOTEL SUMMIT MEDICAL CENTER SUNSET DEVELOPMENT SUNSET DEVELOPMENT COMPANY TISHMAN SPEYER TOWNSHIP ENGINEERING SERVICES ULTIMA HOSPITALITY, LLC DBA THE WESTIN SFO AIRPORT UNI-KOOL COMPANY (SALINAS) UNIVERSAL PARAGON CORPORATION UNIVERSITY OF SAN FRANCISCO URBAN SERVICES GROUP, INC. VERITAS PROPERTY MANAGEMENT W SAN FRANCISCO HOTEL WEINBERG ROGER & ROSENFELD WEST COAST REALTIES, HEARST COMMUNICATIONS, INC. WESTERN CONFERENCE OF OPERATING ENGINEERS WESTIN ST. FRANCIS WORLEYPARSONS CONSTRUCTORS, INC. ZERO WASTE SOLUTIONS