2014-02-21T17:34:59-06:00 2013-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY 400 SAN RAMON CA 94583 990 2012-05-01 941206350 CALIFORNIA SVC EMPLOYEES HEALTH & WELFARE TRUST FUND CALI 5104334452 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 CHARLIE GILCHRIST 5104334452 2014-02-21 1 DEBBIE ROESSL DIMERY P01065763 9252779100 2012 2015-11-30 17:44:51Z CHARLIE GILCHRIST 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 152018209 0 X N/A X 1951 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 4 2 31 0 0 0 0 0 93157082 94158492 5559257 -770405 0 0 98716339 93388087 0 0 88346567 93891598 474159 522139 0 0 0 2029223 2094657 90849949 96508394 7866390 -3120307 135107436 145208854 22392622 25229858 112714814 119978996 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 1 473 0 1 31 1 0 0 0 0 0 0 X 4 2 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 DAVID STILWELL 0.50 X 0 0 0 MIKE GARCIA 0.30 X 0 0 0 CHARLES GILCHRIST 5.00 X 18000 0 23413 RAY NANN 5.00 X 18000 0 23413 LARRY T SMITH 5.00 X 6000 0 23413 42000 0 70239 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 989 MARKET STREET SUITE 320 SAN FRANCISCO CA 94104 FUND ADMINISTRATION 718650 LINDQUIST LLP 5000 EXECUTIVE PARKWAY STE 400 SAN RAMON CA 94583 AUDITING AND ACCOUNTING SERVICES 269835 MCMORGAN & COMPANY 425 MARKET STREET SUITE 1600 SAN FRANCISCO CA 94105 INVESTMENT MANAGER 157323 3 EMPLOYER CONTRIBUTIONS 900099 92659455 92659455 EMPLOYEE CONTRIBUTIONS 900099 994106 994106 STOP LOSS INCOME 900099 316139 316139 PRESCRIPTION CLAIMS REBATE 900099 182700 182700 OTHER INCOME 900099 6092 6092 94158492 2174721 2174721 55684996 58630122 -2945126 -2945126 -2945126 93388087 94158492 0 -770405 93891598 112242 275754 27103 70439 36601 725419 175029 324730 203271 351346 150360 25920 2086 16632 116434 OTHER EXPENSE 3430 96508394 -4550 224947 16063117 10694566 10997880 11392674 23658 74188 107117775 120804544 909556 2017935 135107436 145208854 70542 181487 22322080 25048371 22392622 25229858 X 0 0 0 0 112714814 119978996 112714814 119978996 135107436 145208854 -3120307 10384489 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 21182000 CLAIMS PAYABLE AND IBNR 840000 DUE TO BROKER 2523371 GROUP INSURANCE PREMIUMS PAYABLE 503000 25048371 X 103569305 10384489 10384489 93184816 203271 203271 93388087 95637123 0 95637123 203271 668000 871271 96508394 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 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 APRIL 30, 2010. 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 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. SEE EXPLANATION IN PART VII VARIOUS CA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 APRIL 30, 2013, THERE ARE APPROXIMATELY 83 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 ADMINSTRATIVE 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 MAINTENANCE AEROPORT SERVICES INC. AIR SERV CORPORATION ALBERTSON'S INC.-DOWNEY ALBERTSON'S/LUCKY AMERICAN BLDG MAINT AMERICAN BUILDING MAINTENANCE APPRENTICE & JOURNEYMAN ARAMARK - GALEN CENTER ARAMARK FACILITY SERVICES ARAMARK SERVICEMASTER AVIATION SAFEGUARDS - LAX BLACKSTONE CONSULTING BUNKER HILL TOWER CONDO ASSN CALOP AEROGROUND SERVICES CLEANING MGMT SVCS (CMS) INC. COLUMBIA CLEANING CO. CROTHALL DELMAR THOROUGHBRED CLUB DIVERSIFIED MAINTENANCE SVC ESC BUILDING SERVICES - WESTFIE F E CAMPBELL/CENTURY DENTAL PL FACILITIES SUPPORT SERVICES FLAGSHIP FACILITY SVCS INC. G2 SECURE STAFF - LAX GATEWAY GROUP ONE GCA SERVICES GROUP CO. GELSON'S MARKETS GRAND CENTRAL ASSOCIATES GUARANTEE PEST CONTROL INC. HEALTH & WELFARE OFFICE STAFF HOTEL, RESTAURANT EE'S & HYATT REGENCY CENTRY PLZ HTL ILWU HALL, LOCAL #10 INNOVATIVE FACILITY SVCS LLC 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. LOS ANGELES MEMORIAL COLISEUM MAINTENANCE INDUSTRY FUND MERCHANTS BUILDING MAINTENANCE METRO SERVICE SOUTH, INC. MI FAMILIA VOTA MILLENNIUM BILTMORE HOTEL NATIONAL BLDG SVCS NATIONWIDE JANITORIAL/WESTFIEL ONE STOP BUILDING MAINT. PACIFIC BUILDING CARE PACIFIC MAINTENANCE CO. PACIFIC MAINTENANCE SVC, INC. PEERLESS BLDG MAINT PEGASUS BUILDING SERVICES RACE TRACK L-280 RALPH'S GROCERY COMPANY REGENT BEVERLY WILSHIRE HOTEL SAN DIEGO SPORTS ARENA/LA ARENA SANSTRAND SERVICES SEIU LOCAL 121RN SERVICON SYSTEMS, INC. SERVICON SYSTEMS, INC. SIGNATURE MAINTENANCE SOMERS BUILDING MAINTENANCE STATER BROS MARKETS STEAMFITTERS LOCAL UNION #250 STRENTHENING OUR LIVES (SOL) SUNRISE FLOOR SYSTEMS, LLC SUPER A FOODS TOWNSHIP BUILDING MAINTENANCE UGL UNICCO UNITED BLDG SVC/ABLE UNIVERSAL BLDG MAINT - MCA US METRO GROUP VON'S GROCERY COMPANY WILSHIRE TERRACE APTS. WORLD SERVICE WEST - LAX