2012-10-18T13:30:38-05:00 2012-01-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2011-02-01 946085742 SOLANO-NAPA HEALTH AND WELFARE TRUST FUND SOLA 9252089999 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 DAN R BROADWATER 9252089999 2012-10-18 1 JOSEPH THIERMANN P01066616 9252779100 2011 2016-02-24 21:20:13Z DAN R BROADWATER 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 5651536 0 X N/A X 1954 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS AND THEIR DEPENDENTS. 9 2 0 0 0 0 0 0 8012315 5638294 18075 13242 0 0 8030390 5651536 0 0 6884763 5423683 5086 3485 0 0 0 382002 353972 7271851 5781140 758539 -129604 10406869 9769652 2181358 1673745 8225511 8095907 TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS AND THEIR DEPENDENTS. 0 0 THE PLAN PROVIDED MEDICAL, DENTAL, AND LIFE INSURANCE BENEFITS TO ITS PARTICIPANTS AND THEIR DEPENDENTS 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 206 0 1 0 0 0 0 0 0 0 X 9 2 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1 0 0 0 X BENESYS INC 9252089999 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 JESS ZUNIGA 1.00 X 0 0 0 DEAN LLOYD 1.00 X 334 0 0 RANDY BARACOSA 1.00 X 0 0 0 DAN BROADWATER 1.00 X 0 0 0 DON CAMPBELL 1.00 X 0 0 0 RUBEN PEREZ 1.00 X 0 0 0 STANLEY NELSON 1.00 X 0 0 0 JACK PAULSON 1.00 X 381 0 0 GREG ARMSTRONG 1.00 X 0 0 0 DAVID DOSS 1.00 X 2770 0 0 GREG LONG 1.00 X 0 0 0 3485 0 0 0 0 0 0 BENESYS INC 2610 CROW CANYON ROAD SAN RAMON CA 94583 THIRD PARTY ADMINISTRATOR 172620 1 EMPLOYER CONTRIBUTIONS 900099 5123995 5123995 PARTICIPANT CONTRIBUTI 900099 453632 453632 ERRP INCOME 900099 51098 51098 COBRA SUBSIDY INCOME 900099 9569 9569 5638294 13242 13242 5651536 5638294 0 13242 5423683 3485 180861 30767 62720 6097 39231 12998 8264 13034 5781140 220687 1145273 8962515 8135732 737453 480040 486214 8607 10406869 9769652 93358 96745 2088000 1577000 2181358 1673745 X 0 0 0 0 8225511 8095907 8225511 8095907 10406869 9769652 -129604 0 X 0 0 0 0 ACCUMULATED ELIGIBILITY CREDITS 1577000 1577000 FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH BENESYS, INC TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION AVAILABLE UPON REQUEST. FORM 990, PART VI: FORM 990, PART IV, LINE 12: THE SOLANO NAPA HEALTH AND WELFARE TRUST FUND CONSISTS OF TWO PLANS. THE INDIVIDUAL PLANS HAVE AUDITED FINANCIAL STATEMENTS, HOWEVER THE TRUST DOES NOT. SOLANO-NAPA COUNTIES ELECTRICAL WORKERS PENSION PLAN 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 946220673 TO PROVIDE PENSION BENEFITS TO MEMBERS CA 501(A) N/A N/A 0 SOLANO-NAPA COUNTIES ELECTRICAL WORKERS PROFIT SHARING PLAN 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 946220673 TO PROVIDE PENSION BENFITS TO MEMBERS CA 501(A) N/A N/A 0 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 JANUARY 31, 2012 THERE ARE APPROXIMATELY 77 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.