2013-03-06T13:20:06-06:00 2012-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY 400 SAN RAMON CA 94583 990 2011-05-01 941206350 CALIFORNIA SVC EMPLOYEES HEALTH & WELFARE TRUST FUND CALI 5104334452 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 CHARLIE GILCHRIST 5104334452 2013-03-06 1 DEBBIE ROESSL DIMERY P01065763 9252779100 2011 2016-02-25 16:41:14Z CHARLIE GILCHRIST 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 180810599 0 X N/A X 1951 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 4 2 28 0 0 0 0 0 86371804 93157082 4634675 5559257 0 0 91006479 98716339 0 0 80342238 88346567 467938 474159 0 0 0 2081430 2029223 82891606 90849949 8114873 7866390 124875877 135107436 21390333 22392622 103485544 112714814 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 0 1 776 0 1 28 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 CHARLIE GILCHRIST 5.00 X 18000 0 22270 RAY NANN 5.00 X 18000 0 22270 LARRY T SMITH 0.50 X 0 0 5798 36000 0 50338 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 989 MARKET STREET SUITE 320 SAN FRANCISCO CA 94104 FUND ADMINISTRATION 755160 LINDQUIST LLP 5000 EXECUTIVE PARKWAY STE 400 SAN RAMON CA 94583 AUDITING AND ACCOUNTING SERVICES 292136 MCMORGAN & COMPANY 425 MARKET STREET SUITE 1600 SAN FRANCISCO CA 94105 INVESTMENT MANAGER 198322 3 EMPLOYER CONTRIBUTIONS 900099 91532384 91532384 EMPLOYEE CONTRIBUTIONS 900099 1031366 1031366 STOP LOSS INCOME 900099 519120 519120 PRESCRIPTION CLAIMS RE 900099 64474 64474 OTHER INCOME 900099 9738 9738 93157082 2977862 2977862 84675655 82094260 2581395 2581395 2581395 98716339 93157082 0 5559257 88346567 97385 252833 26630 61306 36005 736405 100576 257563 247873 297673 235104 25920 1718 11285 104464 OTHER EXPENSE 10642 90849949 -527132 -4550 21729435 16063117 10170290 10997880 24671 23658 92588156 107117775 890457 909556 124875877 135107436 70124 70542 21320209 22322080 21390333 22392622 X 0 0 0 0 103485544 112714814 103485544 112714814 124875877 135107436 X 7866390 1362880 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 19778000 CLAIMS PAYABLE AND IBNR 1865000 DUE TO BROKER 465080 GROUP INSURANCE PREMIUMS PAYABLE 214000 22322080 98716339 90849949 7866390 1362880 2714000 4076880 11943270 99831346 1362880 1362880 98468466 247873 247873 98716339 87888076 0 87888076 247873 2714000 2961873 90849949 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF APRIL 30, 2012, 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, 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS PART XIII, 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,362,880. 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. 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 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, 2012 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. HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.