2014-03-06T08:26:35-06:00 2013-05-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2012-06-01 204570305 LONG TERM CARE WORKERS HEALTH TRUST FUND LONG 2133660688 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 SAMUEL COOK 2133660688 2014-03-06 1 SCOTT E HALLBERG CPA P01081188 2023319880 2012 2015-11-30 17:44:51Z SAMUEL COOK 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 11984164 0 X N/A X 2006 CA THE 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. 4 4 0 0 0 0 0 0 17909063 11895777 24477 27567 3592943 60820 21526483 11984164 0 0 14257317 11620027 0 0 0 0 0 1088788 839842 15346105 12459869 6180378 -475705 12095580 11563843 1070713 1014681 11024867 10549162 SEE SCHEDULE O FOR DETAILS. 0 0 THE PLAN PROVIDES HEALTH BENEFITS SUCH AS MEDICAL, DENTAL, AND VISION TO PARTICIPATING EMPLOYEES IN THE IN-HOME SUPPORTIVE SERVICES INDUSTRY OF CALIFORNIA. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 4 0 1 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 CA X ATPA 6262793003 4399 SANTA ANITA AVENUE STE 200 EL MONTE CA 91731 LAPHONZA BUTLER 1.00 X 0 158935 24049 SAMUEL COOK 1.00 X 0 119124 32674 ROSA MUNDY 1.00 X 0 563 0 DAVID WERLIN 1.00 X 0 94615 40011 0 373237 96734 0 0 1 0 ANTHEM BLUE CROSS AND BLUE SHIELD 370 BASSETT ROAD NORTH HAVEN CT 06473 CLAIMS ADMINISTRATOR FEES 310023 ATPA 4399 SANTA ANITA AVE 200 EL MONTE CA 91731 ADMINISTRATOR FEES 300178 SCHWARTZ STEINSAPIR DOHRMANN & SOMMERS 6300 WILSHIRE BOULEVARD SUITE 2000 LOS ANGELES CA 90048 LEGAL FEES 170343 SEGAL COMPANY 330 N BRAND BLVD GLENDALE CA 91203 ACTUARY 116400 4 EMPLOYER CONTRIBUTIONS 900099 11618402 11618402 PARTICIPANT CONTRIBUTIONS 900099 277375 277375 11895777 27567 27567 EXPRESS SCRIPTS REBATES 900099 57768 57768 MISCELLANOUS INCOME 900099 3052 3052 60820 11984164 11956597 0 27567 11620027 113074 27000 85000 30120 50171 ADMINISTRATOR FEES 531612 OTHER EXPENSES 2865 12459869 9346211 10349428 2240458 700914 4227 4177 504684 509324 12095580 11563843 1070713 1014681 1070713 1014681 X 11024867 10549162 11024867 10549162 12095580 11563843 -475705 0 X 0 1 X 0 0 0 11984164 0 11984164 0 11984164 12459869 0 12459869 0 12459869 0 0 0 LAPHONZA BUTLER 0 158935 0 0 0 0 0 22251 0 1798 0 182984 0 0 SAMUEL COOK 0 119124 0 0 0 0 0 16677 0 15997 0 151798 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE TRUSTEE REVIEWS THE FORM 990 BEFORE FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ANY OF ITS DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC. SEIU UNITED LONG-TERM CARE WORKERS LOCAL UNION NO 6434 2910 BEVERLY BLVD LOS ANGELES CA 90057 260718017 UNITE MEMBERS INTO ONE ORG. FOR THE PURPOSE OF IMPROVING WORKING CONDITIONS CA 501(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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0