2015-11-04T18:11:52-06:00 2014-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2014-01-01 941233004 HEAT AND FROST INSULATORS OF NORTHERN CA LOCAL 16 HEALTH AND WELFARE FUND HEAT 9252089999 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 MEL BRESHEARS CHAIRMAN 9252089999 2015-11-04 1 JESSICA R ROSTER P01317380 9252779100 2014 2016-03-07 17:11:31Z X MEL BRESHEARS 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 9364165 0 X N/A X 1952 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS IN THE HEAT AND FROST INSULATORS TRADE. 8 0 0 0 0 0 0 0 8346417 8004792 163671 310340 15 0 8510103 8315132 0 0 8694721 8228950 0 0 0 0 0 588202 598424 9282923 8827374 -772820 -512242 4454233 4072268 2873225 3160758 1581008 911510 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS OF THE HEAT AND FROST INSULATORS OF NORTHERN CA, LOCAL 16. 0 0 THE FUND PROVIDED WELFARE BENEFITS TO COVERED EMPLOYEES AND THEIRDEPENDENTS. 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 3 0 1 0 0 0 0 0 0 0 X 8 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 SUITE 200 PLEASANTON CA 94566 X MATT SEMM ALTERNATE TRUSTEE 1.00 X 0 0 0 SCOTT STRAWBRIDGE ALTERNATE TRUSTEE 1.00 X 0 0 0 BILLY HODGES TRUSTEE 1.00 X 0 0 0 CHRIS GREANEY TRUSTEE 1.00 X 0 0 0 SHAHRAM AMELI TRUSTEE 1.00 X 0 0 0 BILL WHITNEY CO- CHAIRMAN 2.00 X 0 0 0 MEL BRESHEARS CHAIRMAN 2.00 X 0 0 0 ADAM POLKINGHORNE TRUSTEE 1.00 X 0 0 0 SEE SCH O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 1.00 X 0 1 0 0 1 0 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATOR 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 ADMINISTRATION SERVICES 325272 THE SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARIAL AND CONSULTING SERVICES 102331 2 EMPLOYER CONTRIBUTIONS 900099 7425237 7425237 MEMBER/RETIREE CONTRIBUTIONS 900099 537779 537779 MEDICARE RETIREE - DRUG SUBSIDY 900099 41776 41776 8004792 129373 129373 1230000 1049033 180967 180967 180967 8315132 8004792 0 310340 8228950 327743 34788 46785 139645 23711 10785 14967 8827374 278596 886005 91460 100008 617570 697007 5245 4861 3461362 2384387 4454233 4072268 68325 81858 2804900 3078900 2873225 3160758 X 0 0 0 0 1581008 911510 1581008 911510 4454233 4072268 -512242 -157256 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 2672000 PREMIUMS PAYABLE 9900 CLAIMS PAYABLE AND IBNR 397000 3078900 X 8157876 -157256 -157256 8315132 0 8315132 8553374 0 8553374 274000 274000 8827374 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMBER 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 EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2011. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGES IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THROUGH DECEMBER 31, 2014, THE PLAN HAS CONTRACTED WITH ASSOCIATED THIRD PARTY ADMINISTRATORS TO PROVIDE DAY-TO-DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. BEGINNING JANUARY 1, 2015, THE PLAN CONTRACTED WITH BENESYS, INC., TO PROVIDE ADMINISTRATIVE SERVICES. FORM 990, PART VI, SECTION A, LINE 8B THE BOARD OF TRUSTEES DOES NOT CURRENTLY HAVE ANY COMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PRESENTED TO EACH OF THE VOTING MEMBERS OF THE BOARD OF TRUSTEES FOR THEIR REVIEW AND COMMENT PRIOR TO FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES OF THE PLAN HAVE RESPONSIBILITIES TO DISCLOSE ANY CONFLICT OF INTEREST ON AN ANNUAL BASIS. THE PLAN MANAGER AND CHAIRMAN ARE RESPONSIBLE FOR MONITORING THE CONFLICT-OF-INTEREST POLICY AND RESOLUTION OF ANY CONFLICTS. 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, ASSOCIATED THIRD PARTY ADMINISTRATORS. 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 DID NOT CHANGE. HEAT & FROST INSULATORS OF NORTHERN CA LOCAL 16 PRESERVATIONVACATION FUND 7180 KOLL CENTER PARKWAY 200 PLEASANTON CA 94566 943135861 PRESERVATION AND VACATION PLAN CA 501(C)(9) N/A N/A 0 HEAT & FROST INSULATORS & ALLIED WORKERS LOCAL UNION NO 16 3801 PARK ROAD BENICIA CA 94510 940577197 LABOR ORGANIZATION 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, IDENTIFICAITN 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, 2014, THERE ARE APPROXIMATELY 27 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. APPLIED PROCESS COOLING CORP (APPCO) ATLANTIC PLANT SERVICES LLC BAYSIDE INSULATION CONTRACTORS INC BRAND ENERGY SERVICE OF CALIFORNIA COLLINS INSULATION INC CRITCHFIELD MECHANICAL INC DE BELLA MECHANICAL INC DKB INC ECCO INSULATION ECO BAY SERVICES, INC. ENERGY MECHANICAL INSULATION EPIC INSULATION FARWEST INSULATION CONTRACTING GOLDEN BEAR INSULATION INC HEAT & FROST INSULATORS JATC HEAT & FROST INSULATORS LOC 16 INSULATION CONTRACTING & SUPPLY INSULATION SPECIALTIES KARCHER INSULATION INC KC INSULATION PACIFIC STATES INSULATION PARC SERVICES INC (NB) PERFORMANCE CONTRACTING, INC PRMNC ABTMNT SVC OF CALIFORNIA RESTEC CONTRACTORS INC TEMPER INSULATION WEST COAST MECHANICAL INSULATION