2012-11-06T17:30:50-06:00 2011-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2011-01-01 412261950 DISTRICT COUNCIL 16 NORTHERN CALIFORNIA HEALTH AND WELFARE TRUST FUND DIST 5104334400 1640 SOUTH LOOP ROAD ALAMEDA CA 945027089 DOUG CHRISTOPHER 5104334400 2012-11-06 1 JOSEPH M THIERMANN P01066616 9252779100 2011 2016-02-24 21:20:13Z 1640 SOUTH LOOP ROAD ALAMEDA CA 945027089 71491210 0 X HTTP://WWW.DC16TRUSTFUND.ORG X 2008 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 0 215 0 0 0 0 0 60480513 70097040 159707 152212 34263 3113 60674483 70252365 0 0 57253909 54746372 0 0 0 0 0 3457366 3101999 60711275 57848371 -36792 12403994 16483269 27310791 28500690 27051501 -12017421 259290 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 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 83 0 1 215 1 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1 0 0 0 X ASSOCIATED THIRD PARTY ADMINISTRATO 5104334400 1640 SOUTH LOOP ROAD ALAMEDA CA 945027089 X DOUG CHRISTOPHER 1.00 X 0 0 0 LES PROTEAU 1.00 X 0 0 0 JOHN SHERAK 1.00 X 0 0 0 JOHN MAGGIORE 1.00 X 0 0 0 MARIAN BOURBOULIS 1.00 X 0 0 0 CHRIS CHRISTOPHERSEN 1.00 X 0 0 0 DARYL STACY 1.00 X 0 0 0 STEVE LYON - PAST 1.00 X 0 0 0 JOHN KUSPER - ALTERNATE 1.00 X 0 0 0 THOMAS HEINZELMANN - ALTERNATE 1.00 X 0 0 0 STEVE ECKSTROM 1.00 X 0 0 0 FRANK NUNES - ALTERNATE 1.00 X 0 0 0 0 0 0 0 0 0 0 ASSOCIATED THIRD PARTY ADMINISTRATORS 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 FUND ADMINISTRATION 1256443 SALTZMAN AND JOHNSON 44 MONTGOMERY STREET SUITE 2110 SAN FRANCISCO CA 94104 ATTORNEY 494245 ANTHEM BLUE CROSS 700 BROADWAY DENVER CO 80273 COST CONTAINMENT 474384 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDIT 306683 DELTA DENTAL 12898 TOWNE CENTER DRIVE CERRITOS CA 90703 DENTAL CLAIMS PROCESSING 233775 6 EMPLOYER CONTRIBUTIONS 900099 58070693 58070693 PARTICIPANT CONTRIBUTI 900099 9999050 9999050 STOP LOSS REIMBURSEMEN 900099 397786 397786 COBRA STIMULUS INCOME 900099 381164 381164 EARLY RETIREE REISURAN 900099 350265 350265 898082 898082 70097040 39353 39353 1351704 1238845 112859 112859 112859 OTHER INCOME 900099 3113 3113 3113 70252365 70100153 0 152212 54746372 1201394 494245 308895 945956 110639 5870 1863 33137 57848371 4021490 4594662 3059834 15834907 7541627 6758661 19007 1353600 506718 103554 16483269 27310791 7807138 7213056 544911 247391 20148641 19591054 28500690 27051501 X 0 0 0 0 -12017421 259290 -12017421 259290 16483269 27310791 X 12403994 -127283 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 7399089 BENEFIT CLAIMS PAYABLE & IBNR 3310000 DUE TO ANNUITY PLAN 64205 EMPLOYER BOND DEPOSITS 79114 CASH BANK LIABILITY 8738646 19591054 70252365 57848371 12403994 -127283 -1278027 -1405310 10998684 70125082 -127283 -127283 70252365 0 70252365 59126398 0 59126398 -1278027 -1278027 57848371 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 ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011, 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 YEARS PRIOR TO 2008. 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 TRUST 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 FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -127,283. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. SEE EXPLANATION ON 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 DECEMBER 31, 2011 THERE ARE APPROXIMATELY 599 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 AFTER REASONABLE INQUIRY IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.