2011-08-03T16:08:48-05:00 2010-05-31 HEMMING MORSE CPA'S AND CONSULTANTS 160 SPEAR STREET SUITE 1900 SAN FRANCISCO CA 94105 990 2009-06-01 941235152 LABORERS HEALTH & WELFARE TRUST FUND FOR NORTHERN CALIFORNIA LABO 7078642800 220 CAMPUS LANE FAIRFIELD CA 945341498 ED SMITH 7078642800 2011-08-03 1 4158364000 2009 2016-02-24 21:20:13Z X 220 CAMPUS LANE FAIRFIELD CA 945341498 869932437 0 X N/A X 1953 CA SEE PART III LINE 4A 10 10 0 0 0 0 0 166867616 135693302 6779808 15284236 1615638 6256049 175263062 157233587 0 158868744 128721945 0 0 0 12196041 11154616 171064785 139876561 4198277 17357026 191947782 187701286 110061349 83532824 81886433 104168462 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS ACCORDING TO THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE EMPLOYERS AND THE UNION 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 4132 0 0 0 0 0 0 0 0 0 0 0 10 10 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 1 1 0 0 0 X EDWARD SMITH SECRETARY 7078642800 220 CAMPUS LANE fairfield CA 94534 X LARRY TOTTEN 5.00 X 0 0 0 BYRON LONEY 5.00 X 0 0 0 CLAIRE KOENIG 5.00 X 0 0 0 robert chrisp 5.00 X 0 0 0 TERENCE STREET 5.00 X 0 0 0 bruce rust 5.00 X 0 0 0 OSCAR DE LA TORRE 5.00 X 0 0 0 james homer 5.00 X 0 0 0 DOYLE RADFORD 5.00 X 0 0 0 david gorgas 5.00 X 0 0 0 0 0 0 0 0 0 0 LABORERS FUND ADMINISTRATIVE OFFICE OF N 220 CAMPUS LANE FAIRFIELD CA 94534 ADMINISTRATOR 5054284 ANTHEM BLUE CROSS 801 SOUTH FIGUEROA MAIL STOP CAL 2 LOS ANGELES CA 90017 CLAIMS ADMINISTRATION 2414762 Healthways 701 cool springs blvd franklin TN 37067 ClaiMS ADMINISTRATION 993396 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATION 856538 HEALTH AND SAFETY FUND 905 16TH STREET NW WASHINGTON DC 20006 MEDICAL CONSULTING 428847 11 EMPLOYER CONTRIBUTIONS 900099 120632169 120632169 PARTICIPANT contribs 900099 14061723 14061723 COBRA contributions 900099 999410 999410 135693302 8696543 8696543 719286543 712698850 6587693 6587693 6587693 REBATES AND subsidies 900099 3387676 3387676 OTHER INCOME 900099 2713174 2713174 LIQUIDATED DAMAGES 900099 155199 155199 6256049 157233587 148537044 0 8696543 128721945 5054284 290871 48875 495497 2654 15425 Administrative Fees 4926827 CONSULTANT 115758 MEDICAL review services 111390 POSTAGE AND PRINTING 87035 MISCELLANEOUS 5615 385 139876561 9044020 4971177 575347 1095605 13988760 11178436 39729 165467923 145860046 20209015 2832003 4387007 191947782 187701286 2070321 1797170 107991028 81735654 110061349 83532824 X 0 0 0 0 81886433 104168462 81886433 104168462 191947782 187701286 X 0 1 0 X 0 0 DUE TO LABORERS FUNDS ADMINISTRATIVE OFFICES OF NORTHERN CALIFORNIA, INC. 450760 GROUP INSURANCE PEMIUMS PAYABLE 3861081 SELF-FUNDED BENEFIT CLAIMS PAYABLE 19445813 IBNR 17248000 BANK OF HOURS 40730000 81735654 157233587 139876561 17357026 4925003 4925003 22282029 162158590 4925003 4925003 157233587 0 157233587 139876561 0 139876561 0 139876561 Form 990, Part VI, Section A, line 3 THE ORGANIZATION HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS OR TRUSTEES, OR KEY EMPLOYEES TO THE ADMINISTRATIVE OFFICE. Form 990, Part VI, Section A, line 8b THE ORGANIZATION DOES NOT HAVE ANY SUB-COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11 THE TRUSTEES HAVE DESIGNATED THE ADMINISTRATOR TO REVIEW THE FORM PRIOR TO FILING OF THE FORM 990. 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. FORM 990, PART XI, LINE 2C THE BOARD OF TRUSTEES OF THE ORGANIZATION ASSUME'S RESPONSIBILITY FOR THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT AUDITOR. LABORERS PENSION TRUST FUND FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 946277608 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401B LABORERS PENSION TRUST FUND FOR NORTHERN CALIFORNIA - ANNUITY PLAN 220 CAMPUS LANE FAIRFIELD CA 94534 946277608 TO PROVIDE ANNUITY BENEFITS TO ELIGIBLE PARTICIPANTS CA 401B LABORERS VACATION-HOLIDAY TRUST FUND FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 946092198 TO PROVIDE VACATION AND HOLIDAY BENEFITS TO ELIGIBLE PARTICIPANTS CA 501(C)(9) LABORERS TRAINING AND RETRAINING TRUST FUND FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 941688279 TO PROVIDE TRAINING SERVICES TO ELIGIBLE PARTICIPANTS CA 501(C)(3) LABORERS FUND ADMINISTRATIVE OFFICE OF NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 941563547 TO PROVIDE ADMINISTRATIVE SERVICES CA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0