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SEIU LOCAL 2015 LONG TERM CARE WORKERS HEALTH TRUST FUND: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
SEIU LOCAL 2015 LONG TERM CARE WORKERS HEALTH TRUST FUND (EIN 20-4570305)
Tax period
2012-06-01 to 2013-05-31
Filed
2014-03-06
IRS object ID
201420659349300702
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-03-06T08:26:35-06:00Timestamp
Tax Period End Date2013-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN470900880EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CALIBRE CPA GROUP PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line17501 WISCONSIN AVENUE SUITE 1200AddressLine1
Address Line2WESTAddressLine2
CityBETHESDACity
StateMDState
ZIP Code20814ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN204570305EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LONG TERM CARE WORKERS HEALTH TRUST FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLONGNameControl
Phone2133660688Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12910 BEVERLY BOULEVARDAddressLine1
CityLOS ANGELESCity
StateCAState
ZIP Code90057ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSAMUEL COOKName
TitleTRUSTEETitle
Phone2133660688Phone
Date Signed2014-03-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSCOTT E HALLBERG CPAName
PTINP01081188PTIN
Phone2023319880Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSAMUEL COOKNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12910 BEVERLY BOULEVARDAddressLine1
CityLOS ANGELESCity
StateCAState
ZIP Code90057ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11984164GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation2006YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTHE TRUST WAS ESTABLISHED TO MAINTAIN THE LONG TERM CARE WORKERS HEALTH PLAN. THE PLAN WAS CREATED FOR THE EXCLUSIVE BENEFIT OF ELIGIBLE LONG TERM CARE WORKERS. THE PLAN PROVIDES HEALTH BENEFITS (MEDICAL, DENTAL, AND VISION) TO PARTICIPATING EMPLOYEES IN THE IN-HOME SUPPORTIVE SERVICES INDUSTRY OF CALIFORNIA, WHOSE EMPLOYERS ARE REQUIRED, BY CONTRACT, TO PAY CONTRIBUTIONS TO THE TRUST.ActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17909063ProgramServiceRevenuePriorYear
Program Service Revenue CY11895777ProgramServiceRevenueCY
Investment Income Prior Year24477InvestmentIncomePriorYear
Investment Income Current Year27567InvestmentIncomeCurrentYear
Other Revenue Prior Year3592943OtherRevenuePriorYear
Other Revenue Current Year60820OtherRevenueCurrentYear
Total Revenue Prior Year21526483TotalRevenuePriorYear
Total Revenue Current Year11984164TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year14257317BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY11620027BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1088788OtherExpensePriorYear
Other Expenses Current Year839842OtherExpensesCurrentYear
Total Expenses Prior Year15346105TotalExpensesPriorYear
Total Expenses Current Year12459869TotalExpensesCurrentYear
Revenues Less Expenses Prior Year6180378RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-475705RevenuesLessExpensesCY
Total Assets BOY12095580TotalAssetsBOY
Total Assets EOY11563843TotalAssetsEOY
Total Liabilities BOY1070713TotalLiabilitiesBOY
Total Liabilities EOY1014681TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11024867NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10549162NetAssetsOrFundBalancesEOY
Mission DescriptionSEE SCHEDULE O FOR DETAILS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTHE PLAN PROVIDES HEALTH BENEFITS SUCH AS MEDICAL, DENTAL, AND VISION TO PARTICIPATING EMPLOYEES IN THE IN-HOME SUPPORTIVE SERVICES INDUSTRY OF CALIFORNIA.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10964NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ATPABusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6262793003TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14399 SANTA ANITA AVENUE STE 200AddressLine1
CityEL MONTECity
StateCAState
ZIP Code91731ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
LAPHONZA BUTLER
CHAIR1.00X015893524049
SAMUEL COOK
TRUSTEE1.00X011912432674
ROSA MUNDY
TRUSTEE1.00X05630
DAVID WERLIN
TRUSTEE1.00X09461540011
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs373237TotalReportableCompFrmRltdOrgs
Total Other Compensation96734TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ANTHEM BLUE CROSS AND BLUE SHIELD
370 BASSETT ROADNORTH HAVENCT06473CLAIMS ADMINISTRATOR FEES310023
ATPA
4399 SANTA ANITA AVE 200EL MONTECA91731ADMINISTRATOR FEES300178
SCHWARTZ STEINSAPIR DOHRMANN & SOMMERS
6300 WILSHIRE BOULEVARD SUITE 2000LOS ANGELESCA90048LEGAL FEES170343
SEGAL COMPANY
330 N BRAND BLVDGLENDALECA91203ACTUARY116400
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS9000991161840211618402
PARTICIPANT CONTRIBUTIONS900099277375277375
FieldValueIRS element (for citing)
Total Program Service Revenue11895777TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column27567TotalRevenueColumn
Exclusion$27,567ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EXPRESS SCRIPTS REBATES9000995776857768
MISCELLANOUS INCOME90009930523052
FieldValueIRS element (for citing)
Total Other Revenue60820TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11984164TotalRevenueColumn
Related Or Exempt Function Income11956597RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$27,567ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total11620027Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total113074Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total27000Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total85000Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total30120Total

Insurance Insurance

FieldValueIRS element (for citing)
Total50171Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotal
ADMINISTRATOR FEES531612
OTHER EXPENSES2865

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total12459869Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY9346211BOY
EOY10349428EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2240458BOY
EOY700914EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4227BOY
EOY4177EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY504684BOY
EOY509324EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12095580BOY
EOY11563843EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1070713BOY
EOY1014681EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1070713BOY
EOY1014681EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY11024867BOY
EOY10549162EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11024867BOY
EOY10549162EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12095580BOY
EOY11563843EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-475705ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee0AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt11984164TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal11984164RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99011984164TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt12459869TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal12459869ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99012459869TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
LAPHONZA BUTLER
CHAIR0158935000002225101798018298400
SAMUEL COOK
TRUSTEE01191240000016677015997015179800

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE TRUSTEE REVIEWS THE FORM 990 BEFORE FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE ANY OF ITS DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionControlled OrgControlledOrg
SEIU UNITED LONG-TERM CARE WORKERS LOCAL UNION NO 6434
2910 BEVERLY BLVDLOS ANGELESCA90057260718017UNITE MEMBERS INTO ONE ORG. FOR THE PURPOSE OF IMPROVING WORKING CONDITIONSCA501(C)(5)0
DEL NORTE COUNTY - STATE OF CALIFORNIA
COUNTY OF MADERA - STATE OF CALIFORNIA
COUNTY OF SAN BENITO - STATE OF CALIFORNIA
COUNTY OF SANTA CRUZ - STATE OF CALIFORNIA
COUNTY OF VENTURA - STATE OF CALIFORNIA
BUTTE COUNTY - STATE OF CALIFORNIA
IMPERIAL COUNTY - STATE OF CALIFORNIA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg