2013-11-07T15:49:13-06:00 2012-12-31 300702322 HEMMING MORSE CPA'S AND CONSULTANTS 155 BOVET ROAD SUITE 600 SAN MATEO CA 94402 990 2012-01-01 946401544 U A LOCAL 393 HEALTH & WELFARE TR UALO 4084368210 1731 TECHNOLOGY DRIVE SUITE 570 SAN JOSE CA 95110 BILL MEYER 4084368210 2013-11-07 1 4158364000 2012 2016-03-07 17:11:31Z BILL MEYER 1731 TECHNOLOGY DRIVE SUITE 570 SAN JOSE CA 95110 58330565 0 X N/A X 1952 CA TO PROVIDE ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS WITH HEALTH & WELFARE BENEFITS. 8 8 353 0 0 0 0 0 34241593 41072399 950173 866651 454030 357782 35645796 42296832 0 0 32334833 33724654 0 0 0 0 0 1607790 1668152 33942623 35392806 1703173 6904026 54349913 66479441 29660324 33057798 24689589 33421643 NONE 0 0 TO PROVIDE ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS WITH HEALTH & WELFARE BENEFITS ACCORDING TO COLLECTIVE BARGAINING AGREEMENTS BETWEEN EMPLOYERS AND THE UNION. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 1 479 0 353 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X BENESYS ADMINISTRATORS 4084368210 1731 TECHNOLOGY DRIVE SUITE 570 SAN JOSE CA 95110 X DOUG JONES 5.00 X 0 0 0 SCOTT STRAWBRIDGE 5.00 X 0 0 0 MICHAEL J VLAMING 5.00 X 0 0 0 LARRY GATES 5.00 X 0 0 0 WAYD LA PEARLE 5.00 X 0 0 0 BILL MEYER 5.00 X 0 0 0 GARY GLENN 5.00 X 0 0 0 GREGORY GONZALES 5.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS ADMINISTRATORS 1731 TECHNOLOGY DRIVE SUITE 570 SAN JOSE CA 95110 CONTRACT ADMINISTRATOR 540873 DELTA DENTAL PO BOX 444460 SAN FRANCISCO CA 94144 CLAIMS ADMINISTRATOR 287902 BLUE CROSS OF CALIFORNIA 21555 OXNARD STREET WOODLAND HILLS CA 91367 CLAIMS ADMINISTRATOR 131266 TOM ALEXANDER C/0 UA LOCAL 393 1731 TECHNOLOGY D SAN JOSE CA 95110 MEMBER ADVOCATE 124767 4 EMPLOYER CONTRIBUTIONS 900099 42341415 42341415 COBRA CONTRIBUTIONS 900099 33174 33174 COBRA SUBSIDY 900099 14531 14531 RECIPROCITY CONTRIBUTIONS 900099 -1316721 -1316721 41072399 951906 951906 15948478 16033733 -85255 -85255 -85255 MEDICARE D SUBSIDY 900099 294190 294190 OTHER INCOME 900099 49314 49314 LIQUIDATED DAMAGES 900099 14278 14278 357782 42296832 41344926 0 951906 33724654 540873 70986 78770 125950 44504 1761 DELTA DENTAL 287902 BLUE CROSS 131266 MEMBER ADVOCATE 124767 BENEFIT CONSULTING 90000 171373 35392806 2004496 1744309 5218083 11338887 3048803 4337150 2406 2521 43787266 48627014 288859 429560 54349913 66479441 588282 1646048 29072042 31411750 29660324 33057798 X 0 0 0 0 24689589 33421643 24689589 33421643 54349913 66479441 6904026 1828028 0 X X 0 1 X 1 0 0 SELF FUNDED BENEFITS PAYABLE 3146554 GROUP INSURANCE PREMIUMS PAYABLE 2450192 BANK OF HRS LIABILITY FOR EXT. COVERAGE 9289200 PARTICIPANT RESERVE ACCOUNT 15485404 CLAIMS INCURRED BUT NOT REPORTED 1040400 31411750 44124860 1828028 1828028 42296832 0 42296832 35392806 0 35392806 0 35392806 FORM 990, PART IV, LINE 34 THE TRUST FUND HAS A SPECIFIC PROCEDURE IN PLACE FOR THIS NEW DISCLOSURE REQUIREMENT ON THE SCHEDULE R. THE ADMINISTRATOR HAS SENT OUT A QUESTIONNAIRE TO OBTAIN THE REQUIRED INFORMATION FROM THE CONTRIBUTING EMPLOYERS. THE ABOVE INFORMATION REPRESENTS WHAT THE TRUST FUNDS HAS RECEIVED TO DATE. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES TO THE CONTRACT ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE TRUSTEES DESIGNATE THE ADMINISTRATOR TO REVIEW THE FORM. FORM 990, PART VI, SECTION B, LINE 12C REVIEW WITH BOARD OF TRUSTEES ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST TO ALL PLAN PARTICIPANTS. FORM 990, PART XI, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSEEING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR SELECTING THE INDEPENDENT AUDITOR. 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