2011-02-28T11:58:21-06:00 2010-04-30 Lindquist LLP 5000 Executive Parkway Suite 400 San Ramon CA 94583 990 2009-05-01 946284253 Joint Benefit Trust JOIN 9254497070 160 Airway Boulevard Livermore CA 94550 JOHN HURLEY 9254497070 2011-02-28 1 9252779100 2009 2016-02-24 21:20:13Z JOHN HURLEY 160 Airway Boulevard Livermore CA 94550 89872469 0 X n/a X 1972 CA PROVIDE HEALTH AND WELFARE BENEFITS 8 8 0 0 0 0 0 51555995 49692180 608547 566681 39712 30448 52204254 50289309 0 45129056 46511960 0 0 0 5302104 5533345 50431160 52045305 1773094 -1755996 32428440 31597279 8726938 9794788 23701502 21802491 To provide health and welfare benefits. 0 0 health and welfare benefits provided under collective bargaining for participants. 0 0 0 0 0 0 0 0 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 1 1272 0 1 0 0 0 0 0 0 8 8 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICE BENEFIT ADMIN 9254497070 160 AIRWAY BOULEVARD LIVERMORE CA 94550 X JOHN HAILSTONE 2.00 X 0 0 0 Crescencio Diaz 2.00 X 0 0 0 Lupe Juarez 2.00 X 0 0 0 LUCIO REYES 2.00 X 0 0 0 JOHN HURLEY 2.00 X 0 0 0 RICHARD W MUTO 2.00 X 0 0 0 TOM NETT 2.00 X 0 0 0 RICHARD EHRLER 2.00 X 0 0 0 TONY GONZALEZ 2.00 X 0 0 0 0 0 0 0 0 0 0 Health Service Benefit admin 160 Airway Boulevard Livermore CA 94550 Administrator Fees 3016306 blue cross of california DEPARTMENT 5812 LOS ANGELES CA 900745812 ppo network fee 624818 american health ways PO BOX 166718 ATLANTA GA 303687180 AdministratION Fees 278661 the segal company 100 montgomery street suite 500 san francisco CA 94104 ACTUARIAL AND CUNSULTING FEES 263086 caremark Rx Inc PO BOX 848001 DALLAS TX 752848001 pharmacy benefits manager 181495 5 Employer Contributions 900099 45900269 45900269 Employee Contributions 900099 2724171 2724171 Stop-Loss Recovery 900099 593417 593417 Prescription Rebate In 900099 337523 337523 Cobra Subsidy 900099 136800 136800 49692180 562958 562958 39586883 39583160 3723 3723 3723 Other Income 900099 30448 30448 30448 50289309 49722628 0 566681 46511960 2872594 206206 94031 56320 1742052 369488 10426 101940 60152 Other Expenses 20136 52045305 1195890 413662 4523556 4138402 17822 12445 506221 506221 0 0 26142655 26607356 548517 425414 32428440 31597279 211573 242543 8515365 9552245 8726938 9794788 X 0 0 0 0 23701502 21802491 23701502 21802491 32428440 31597279 X 0 1 1 X 0 443209 443209 0 63012 63012 0 0 Accumulated Eligibility Credits 3921245 Group Ins Premiums Payable 1312000 Claims Payable and IBNR 4319000 9552245 50289309 52045305 -1755996 -143015 1036880 893865 -862131 50089974 -143015 -143015 50232989 56320 56320 50289309 50952105 0 50952105 56320 1036880 1093200 52045305 Part XI, Line 8 - Other Adjustments: cHANGES IN BENEFIT OBLIGATIONS Part XIII, Line 4b - Other Adjustments: cHANGES IN BENEFIT OBLIGATIONS Form 990, Part VI, Section A, line 3 THE TRUST HAS CONTRACTED WITH Health Service Benefit Administrators, Inc. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. Form 990, Part VI, Section A, line 8b There is no committee with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 A copy of the Form 990 was provided to all members of the governing body BEFORE IT WAS FILED. Form 990, Part VI, Section B, line 12c At least annually, Trustees and other individuals subject to the conflict of interest policy will be asked to disclose in writing any relationships or interest that could give rise to a conflict. Form 990, Part VI, Section C, line 19 All governing documents, CONFLICT OF INTEREST POLICY and financial statements are available to the public upon request. Form 990, Part XI, Line 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS. HEALTH SERVICES FOUNDATION 160 AIRWAY BOULEVARD LIVERMORE CA 94551 942260587 TO PROVIDE MEDICAL EXAMINATIONS CA 501(c)(4) n/a N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0