2012-10-26T11:46:10-05:00 2011-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2011-01-01 946171641 STATIONARY ENGINEERS LOCAL 39 HEALTH AND WELFARE PLAN STAT 9252089999 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 PAUL BENSI 9252089999 2012-10-26 1 JOSEPH M THIERMANN P01066616 9252779100 2011 2016-02-24 21:20:13Z X PAUL BENSI 7180 KOLL CENTER PARKWAY NO 200 PLEASANTON CA 94566 71510957 0 X N/A X 1965 CA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS 4 0 0 0 0 0 0 0 49787245 53700935 1136880 1936073 0 0 50924125 55637008 0 0 48640003 52491773 0 0 0 0 0 1346243 1377856 49986246 53869629 937879 1767379 36332732 38006206 10890366 12120964 25442366 25885242 TO PROVIDE MEDICAL, DENTAL, VISION AND LIFE INSURANCE BENEFITS TO ELIGIBLE MEMBERS OF THE PLAN AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH & 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 1 809 0 1 0 0 0 0 0 0 0 X 4 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X BENESYS INC 9252089999 7180 KOLL CENTER PARKWAY 200 PLEASANTON CA 94566 X JERRY KALMAR 1.00 X 0 0 0 BART FLORENCE 1.00 X 0 0 0 PAUL BENSI 1.00 X 0 0 0 LYLE SETTER 1.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS 7180 KOLL CENTER PKWY SUITE 200 PLEASANTON CA 94566 THIRD PARTY ADMINISTRATION SERVICES 364909 ASSOCIATED THIRD PARTY ADMINISTRATOR 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 THIRD PARTY ADMINISTRATION SERVICES 271490 DELTA DENTAL PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS ADMINISTRATION FEES 202917 WEINBERG ROGER & ROSENFELD 1001 MARINA VILLAGE PKWY SUITE 200 ALAMEDA CA 94501 LEGAL SERVICES 160283 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 5000 SAN RAMON CA 94583 ACCOUNTANTING SERVICES 124768 5 EMPLOYER CONTRIBUTIONS 900099 51994203 51994203 PARTICIPANT CONTRIBUTI 900099 1136187 1136187 STOP LOSS REIMBURSEMEN 900099 344833 344833 PRESCRIPTION DRUG REBA 900099 156478 156478 COBRA SUBSIDY 900099 69234 69234 53700935 1285996 1285996 16524026 15873949 650077 650077 650077 55637008 53700935 0 1936073 52491773 606903 161118 124768 16000 388099 53048 7887 5141 14892 53869629 1999265 3100917 3284006 2418199 4455657 4876750 132796 26593804 27477544 36332732 38006206 2197466 2480265 81900 96699 8611000 9544000 10890366 12120964 X 0 0 0 0 25442366 25885242 25442366 25885242 36332732 38006206 X 1767379 -1324503 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 9544000 9544000 55637008 53869629 1767379 -1324503 1125305 -199198 1568181 54296505 -1324503 -1324503 55621008 16000 16000 55637008 52728324 0 52728324 16000 1125305 1141305 53869629 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT AS OF DECEMEBER 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'S ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION FOR THE YEARS PRIOR TO THE FISCAL YEAR ENDING DECEMEBER 31, 2008. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH BENESYS, INC. TO PROVIDE DAY TO DAY ADMINISTRATIVE SERVICES FOR THE ORGANIZATION EFFECTIVE JUNE 2011. PRIOR TO JUNE 2011, ASSOCIATED THIRD PARTY ADMINISTRATORS PROVIDED ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES TO ACT ON THE BEHALF OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO EACH OF THE VOTING MEMBERS WITHIN THE ORGANIZATION'S GOVERNING BODY TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY COMPLYING WITH ALL APPLICABLE PROVISIONS OF ERISA, INCLUDING PARTY IN INTEREST AND CONFLICT OF INTEREST PROVISIONS OF ERISA SECTION 406. ANY CONFLICTS OR POTENTIAL CONFLICTS ARE REPORTABLE TO THE CHAIRMAN OF THE BOARD OF TRUSTEES AND LEGAL COUNSEL FOR THE PLAN. 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: -1,324,503. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. STATIONARY ENGINEERS LOCAL 39 PENSION 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 946118939 UNION PENSION PLAN CA 501(A) N/A N/A 0 STATIONARY ENGINEERS LOCAL 39 ANNUITY 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 942787714 UNION ANNUITY PLAN 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 DECEMBER 31, 2011 THERE ARE APPROXIMATELY 177 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.