2014-11-17T12:05:41-06:00 2013-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2013-01-01 412261950 DISTRICT COUNCIL 16 NORTHERN CALIFORNIA HEALTH AND WELFARE TRUST FUND DIST 5104334400 1640 SOUTH LOOP ROAD ALAMEDA CA 945027089 CHRIS CHRISTOPHERSEN TRUSTEE 5104334400 2014-11-17 1 JOSEPH M THIERMANN P01066616 9252779100 2013 2015-11-30 17:44:51Z 1640 SOUTH LOOP ROAD ALAMEDA CA 945027089 108962984 0 X HTTP://WWW.DC16TRUSTFUND.ORG X 2008 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 0 99 0 0 0 0 0 82537931 96944517 247233 696301 115512 41307 82900676 97682125 0 0 70705136 81399857 0 0 0 0 0 3514580 3883975 74219716 85283832 8680960 12398293 37219800 55192082 28145058 33484170 9074742 21707912 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 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 59 0 1 99 1 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 1 0 0 0 X ASSOCIATED THIRD PARTY ADMINISTRATORS 5104334400 1640 SOUTH LOOP ROAD ALAMEDA CA 945027089 VINCE ECHEVERRIA - ALTERNATE TRUSTEE 1.00 X 0 0 0 LES PROTEAU TRUSTEE 1.00 X 0 0 0 JOHN SHERAK TRUSTEE 1.00 X 0 0 0 JOHN MAGGIORE TRUSTEE 1.00 X 0 0 0 MARIAN BOURBOULIS TRUSTEE 1.00 X 0 0 0 CHRIS CHRISTOPHERSEN TRUSTEE 1.00 X 0 0 0 DARYL STACY TRUSTEE 1.00 X 0 0 0 JOHN KUSPER - ALTERNATE TRUSTEE 1.00 X 0 0 0 THOMAS HEINZELMANN - ALTERNATE TRUSTEE 1.00 X 0 0 0 STEVE ECKSTROM TRUSTEE 1.00 X 0 0 0 FRANK NUNES - ALTERNATE TRUSTEE 1.00 X 0 0 0 JOE UPCHURCH TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAI BY RELATED ORGANIZATION 0.00 X 0 1 0 0 1 0 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 FUND ADMINISTRATION 1804756 ANTHEM BLUE CROSS 700 BROADWAY DENVER CO 80273 COST CONTAINMENT 509803 SALTZMAN AND JOHNSON 44 MONTGOMERY STREET SUITE 2110 SAN FRANCISCO CA 94104 ATTORNEY 332912 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDITOR 332623 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 BENEFITS ADMINISTRATION 294353 7 EMPLOYER CONTRIBUTIONS 900099 85932147 85932147 PARTICIPANT CONTRIBUTIONS 900099 8708315 8708315 REFUND OF PREMIUMS 900099 1367965 1367965 RETIREE DRUG SUBSIDY 900099 360405 360405 STOP LOSS REIMBURSEMENT 900099 329656 329656 246029 246029 96944517 581126 581126 11396034 11280859 115175 115175 115175 OTHER INCOME 900099 41307 41307 41307 97682125 96944517 0 737608 81399857 1755138 332912 338682 23986 1291387 105615 327 1824 34104 85283832 11631220 11417035 7975694 7916309 6960978 11243227 23975 24647 10582213 24551124 45720 39740 37219800 55192082 1078500 514238 208964 187069 26857594 32782863 28145058 33484170 X 0 0 0 0 9074742 21707912 9074742 21707912 37219800 55192082 12398293 234877 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 10033254 BENEFIT CLAIMS PAYABLE & IBNR 5356000 EMPLOYER BOND DEPOSITS 79114 CASH BANK LIABILITY 17032270 DUE TO RELATED ENTITY 282225 32782863 X 97893016 234877 234877 97658139 23986 23986 97682125 80138561 0 80138561 23986 5121285 5145271 85283832 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, 2013, 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 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGES IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS DELEGATED CERTAIN MANAGEMENT DUTIES TO A THIRD-PARTY ADMINISTRATOR UNDER THE SUPERVISION OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY FOR REVIEW BEFORE FILING. 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 BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFMORMATION, PLEASE CONTACT THE ADMINISTRATOR. DISTRICT COUNCIL NO 16 2705 CONSTITUTION DRIVE LIVERMORE CA 945509206 940433056 EMPLOYEE SPONSORING 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, PART VII: 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 DECEMBER 31, 2013, THERE ARE APPROXIMATELY 540 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. 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