STRATEGY STUDIO / PUBLIC DATA EXPLORER

ELECTRICAL WORKERS HEALTH & WELFARE TRUST FUND: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ELECTRICAL WORKERS HEALTH & WELFARE TRUST FUND (EIN 88-6002904)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-07
IRS object ID
201343119349301324
Schema version
2012v2.0
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)
Timestamp2013-11-07T10:15:54-08:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BERRY & CO CPAS LTDBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line17030 SMOKE RANCH RDAddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code891281202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN886002904EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ELECTRICAL WORKERS HEALTH & WELFARE TRUST FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlELECNameControl
Phone7027348601Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12250 S RANCHO DRIVEAddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code89102ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMAX CARTER IIName
TitleTRUSTEETitle
Phone7027348601Phone
Date Signed2013-11-07DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDAVID BERRYName
Phone7025150408Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMAX CARTER IINameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12250 S RANCHO DR SUITE 295AddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code89102ZIPCode
FieldValueIRS element (for citing)
Gross Receipts71641884GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1956YearFormation
State Legal DomicileNVStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH & WELFARE BENEFIT COVERAGE FOR PARTICIPANTS AND THEIR BENEFICIARIESActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees70TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year22686849ProgramServiceRevenuePriorYear
Program Service Revenue CY23318260ProgramServiceRevenueCY
Investment Income Prior Year1061749InvestmentIncomePriorYear
Investment Income Current Year1698047InvestmentIncomeCurrentYear
Other Revenue Prior Year1360607OtherRevenuePriorYear
Other Revenue Current Year1156081OtherRevenueCurrentYear
Total Revenue Prior Year25109205TotalRevenuePriorYear
Total Revenue Current Year26172388TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year35784190BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY27384872BenefitsPaidToMembersCY
Salaries Etc Prior Year140716SalariesEtcPriorYear
Salaries Etc Current Year155034SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3190497OtherExpensePriorYear
Other Expenses Current Year2874858OtherExpensesCurrentYear
Total Expenses Prior Year39115403TotalExpensesPriorYear
Total Expenses Current Year30414764TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-14006198RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-4242376RevenuesLessExpensesCY
Total Assets BOY27784269TotalAssetsBOY
Total Assets EOY23106577TotalAssetsEOY
Total Liabilities BOY128704TotalLiabilitiesBOY
Total Liabilities EOY67468TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY27655565NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY23039109NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH & WELFAREMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionTO PROVIDE HEALTH & WELFARE BENEFIT COVERAGE FOR PARTICIPANTS AND THEIR BENEFICIARIESDescription
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees70NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ZENITH ADMINISTRATORS INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7027348601TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12250 S RANCHO SUITE 295AddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code89102ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorHighest Compensated EmployeeHighestCompensatedEmployeeReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MAX CARTER II
TRUSTEE2.00X
MICKEY MILES
TRUSTEE2.00X
RAQUEL DEXTER
TRUSTEE2.00X
AL DAVIS
TRUSTEE2.00X
JEFFREY WESTOVER
TRUSTEE2.00X
CHRIS WILE
TRUSTEE2.00X
JIM ROBERTSON
TRUSTEE2.00X
PATRICK ARMOUR
TRUSTEE2.00X
DAVID BENNETT
TRUSTEE2.00X
CANDACE FACIO
FUND NURSE48.00X103847042408
FieldValueIRS element (for citing)
Total Reportable Comp From Org103847TotalReportableCompFromOrg
Total Other Compensation42408TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BROWNSTEIN HYATT FARBER SCHRECK
100 N CITY PKWY 1600LAS VEGASNV89106LEGAL131008
ZENITH AMERICAN
2250 SOUTH RANCHO SUITE 295LAS VEGASNV89102ADMINISTRATOR1116089
MILLIMAN USA
650 CALIFORNIA ST 17TH FLOORSAN FRANCISCOCA94108CONSULTING108292
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumn
EMPLOYER CONTRIBUTIONS52510020542104
EMPLOYEE SELF PAYS5251002776156
FieldValueIRS element (for citing)
Total Program Service Revenue23318260TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column644945TotalRevenueColumn
Exclusion$644,945ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities38162528Securities
Other8360070Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities38158440Securities
Other7311056Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4088Securities
Other1049014Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1053102TotalRevenueColumn
Exclusion$1,053,102ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
STOP LOSS CLAIM RECOVERY900099245471245471
SUBROGATION900099182295182295
MEDICARE PART D RDS900099541653541653

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column186662TotalRevenueColumn
Related Or Exempt Function Income186662RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1156081TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column26172388TotalRevenueColumn
Related Or Exempt Function Income24474341RelatedOrExemptFunctionIncome
Exclusion$1,698,047ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total27384872Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total103847Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total23456Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total18953Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total8778Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total131008Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total57882Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total159593Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total184972Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11357Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7466Total

Insurance Insurance

FieldValueIRS element (for citing)
Total40283Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
UTILIZATION & REVIEW SERVICES573840
ADMINISTRATIVE FEES1116089
CONSULTANT FEES537669
FUND NURSE EXPENSES16661

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total38038Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total30414764Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5104845BOY
EOY7346853EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis37328LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11025LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY33769BOY
EOY26303EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY22645655BOY
EOY8076058EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY7657363EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY27784269BOY
EOY23106577EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY128704BOY
EOY67468EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY128704BOY
EOY67468EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY27655565BOY
EOY23039109EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY27655565BOY
EOY23039109EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY27784269BOY
EOY23106577EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-4242376ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-374080ReconciliationUnrealizedInvest
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis37328OtherCostOrOtherBasis
Depreciation11025Depreciation
Book Value26303BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings26303TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
COMMON COLLECTIVE TRUSTS2220951F
HEDGE FUND5436412F
FieldValueIRS element (for citing)
Total Of Book Value Securities7657363TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionOVERDRAFT LIABILITYDescription
Amount$67,468Amount
FieldValueIRS element (for citing)
Total Of Amounts67468TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt27077600TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-374080NetUnrealizedGainsInvestments
Other Revenues1279292OtherRevenues
Revenue Not Rptd F990905212RevenueNotRptdF990
Revenue Subtotal26172388RevenueSubtotal
Total Revenue Per Form99026172388TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt29510054TotExpensesEtcAuditedFinclStmt
Other Expenses Included-904710OtherExpensesIncluded
Expenses Not Rptd F990-904710ExpensesNotRptdF990
Expenses Subtotal30414764ExpensesSubtotal
Total Expenses Per Form99030414764TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierExplanationExplanation
Pt XI Line 2dADJUSTMENTS MADE TO REFLECT CASH BASIS FORM 990
Pt XII Line 2dADJUSTMENTS MADE TO REFLECT CASH BASIS FORM 990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 11bFORM 990 IS REVIEWED BY THE GOVERNING BODY PRIOR TO FILING
Pt VI, Line 12cTHE GOVERNING BODY DISCLOSES ANY CONFLICTS THAT HAVE ARISEN
Pt VI, Line 15aDETERMINING COMPENSATION WAS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES
Pt VI, Line 19PURSUANT TO ERISA
Form 990EZ, Part II, Line 24INVESTMENTS
Form 990, Part IX, Line 24fDISABILITY FEDERAL TAXES 38038.

Schedule R IRS990ScheduleR

FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII (7 entries)

ExplanationExplanation
SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS. THE FILING ORGANIZATION IS A
TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH & WELFARE BENEFITS
TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. THE ADMINISTRATIVE OFFICE MAINTAINS A
DATABASE OF CONTRIBUTING EMPLOYERS HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED
TO BE REPORTED ON SCHEDULE R IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND
IT COULD NOT BE REASONABLY OBTAINED. THE CONTRIBUTING
EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.