2011-10-28T18:45:16-05:00 2010-12-31 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2010-01-01 946171641 STATIONARY ENGINEERS LOCAL 39 HEALTH AND WELFARE PLAN STAT 9252089999 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 PAUL BENSI 9252089999 2011-10-28 1 9252779100 2010 2016-03-07 17:11:31Z X PAUL BENSI 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 52069805 0 X N/A X 1965 CA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS 4 4 0 0 0 0 0 0 47052453 49787245 -1525777 1136880 3758 0 45530434 50924125 0 0 43932761 48640003 0 0 0 0 0 1278182 1346243 45210943 49986246 319491 937879 34171879 36332732 11031577 10890366 23140302 25442366 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 1 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 1 0 0 0 1 777 0 1 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 CA X BENESYS INC 9252089999 2610 CROW CANYON ROAD 200 SAN RAMON CA 94583 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 ASSOCIATED THIRD PARTY ADMINISTRATOR 1640 SOUTH LOOP ROAD ALAMEDA CA 94502 THIRD PARTY ADMINISTRATION SERVICES 674672 DELTA DENTAL PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS ADMINISTRATION FEES 213201 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 5000 SAN RAMON CA 94583 ACCOUNTANT 104036 3 EMPLOYER CONTRIBUTIONS 900099 47403868 47403868 PARTICIPANT CONTRIBUTI 900099 1228058 1228058 STOP LOSS REIMBURSEMEN 900099 876410 876410 COBRA SUBSIDY 900099 195302 195302 EARLY RETIREE REINSURA 900099 68430 68430 15177 15177 49787245 891045 891045 1391515 1145680 245835 245835 245835 50924125 49787245 0 1136880 48640003 625853 75175 104036 17350 413790 72807 16755 5380 15087 OTHER EXPENSES 10 49986246 3666492 1999265 2286802 3284006 4313919 4455657 23904666 26593804 34171879 36332732 2638238 2197466 73339 81900 8320000 8611000 11031577 10890366 X 0 0 0 0 23140302 25442366 23140302 25442366 34171879 36332732 X 937879 1364185 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 8611000 8611000 50924125 49986246 937879 1364185 354623 1718808 2656687 52270960 1364185 1364185 50906775 17350 17350 50924125 49614273 0 49614273 17350 354623 371973 49986246 PART XIII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH ASSOCIATED THIRD PARTY ADMINISTRATORS TO PROVIDE DAY TO DAY 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 GAINS ON INVESTMENTS: 1,364,185. 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. 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