2023-11-07T08:22:16-06:00 2022-12-31 WITHUMSMITHBROWNPC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2022-01-01 946170245 WESTERN STATES INSUL AND ALLIED WORKERS HEALTH PLAN % BENESYS ADMINISTRATORS WEST 8003200184 7180 KOLL CENTER PARKWAY Suite 200 PLEASANTON CA 94566 MICHAEL PATTERSON TRUSTEE 8003200184 2023-11-02 true MICHAEL PATTERSON 999009999 JESSICA R ROSTER P01317380 9252779100 2022 2023-04-26 12:10:37Z MICHAEL PATTERSON 7180 KOLL CENTER PARKWAY 200 PLEASANTON CA 94566 40811 false X N/A X 1967 CA TO PROVIDE PERIODIC MEDICAL EXAMINATION AND DISABILITY BENEFITS TO PARTICIPANTS IN A MULTIEMPLOYER PLAN. 8 0 0 0 0 0 0 0 39333 39975 1499 836 0 0 40832 40811 0 0 123414 -20015 0 0 0 0 0 129740 152416 253154 132401 -212322 -91590 1609742 1401199 402185 285232 1207557 1115967 TO PROVIDE PERIODIC MEDICAL EXAMINATION AND DISABILITY BENEFITS TO COVERED PARTICIPANTS IN A MULTIEMPLOYER PLAN. false false THE PLAN PROVIDED PERIODIC MEDICAL EXAMINATION BENEFITS TO COVERED PARTICIPANTS IN A MULTIEMPLOYER PLAN. THE PLAN PROVIDED LONG-TERM DISABILITY BENEFITS TO "GRANDFATHERED" PARTICIPANTS THROUGHOUT THE PLAN YEAR IN A MULTIEMPLOYER PLAN. false false false false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 0 0 true 0 false false false false false false false false X 8 0 false true false false false false false true true false false true false false false false false false CA X BENESYS ADMINISTRATORS 8003200184 7180 KOLL CENTER PARKWAY PLEASANTON CA 94566 X RICK JOHNSON CO-CHAIRMAN - thru 9/1/22 0.5 0.0 X 0 0 0 ERIC FULTS TRUSTEE 0.5 0.0 X 0 0 0 CRAIG SKEIE TRUSTEE 0.5 0.0 X 0 0 0 RICK SUTPHIN CHAIRMAN 0.5 0.0 X 0 0 0 MICHAEL PATTERSON CO-CHAIRMAN 0.5 0.0 X 0 0 0 RICHARD CHAMBERLAIN TRUSTEE 0.5 0.0 X 0 0 0 MATTHEW GONZALES TRUSTEE 0.5 0.0 X 0 0 0 GREG ZEVELY TRUSTEE 0.5 0.0 X 0 0 0 DANIEL HAGUEWOOD TRUSTEE (effective 9/1/22) 0.5 0.0 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.0 0.0 X 0 0 0 0 0 0 0 false false false 0 0 EMPLOYER CONTRIBUTIONS 900099 39975 39975 39975 836 836 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40811 39975 0 836 X 0 0 0 -20015 0 0 0 0 0 0 43733 13145 16840 0 0 0 70065 0 6322 0 0 0 0 0 2181 0 0 0 130 132401 690253 480533 916211 917046 0 0 3192 3399 0 0 0 0 0 0 0 0 86 221 0 0 0 0 0 0 0 0 0 0 0 0 1609742 1401199 24785 22932 0 0 0 0 0 0 0 0 0 0 0 0 0 0 377400 262300 402185 285232 X 0 0 0 0 1207557 1115967 1207557 1115967 1609742 1401199 -91590 X X false true X true false 0 CLAIMS PAYABLE & IBNR 10100 ACCUMULATED ELIGIBILITY CREDITS 252200 262300 X 40811 40811 40811 247501 247501 -115100 -115100 132401 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2022, 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 EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2019. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS: (115,100) FORM 990, PART VI, SECTION A, LINE 3: THE TRUST CONTRACTED WITH BENESYS ADMINISTRATORS, TO PROVIDE ADMINISTRATIVE SERVICES FOR THE PLAN. FORM 990, PART VI, SECTION B, LINE 11B: A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION AVAILABLE TO THE PARTICIPANTS OF THE ORGANIZATION. FORM 990, PART VII, SECTION A, LINE 1A: COMPENSATION PAID TO TRUSTEES EMPLOYED BY RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR. 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. FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PROGRAM ADMIN. TOTAL FEES:66072 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING FEES TOTAL FEES:3993 WESTERN STATES INSULATORS & ALLIED WORKE 7180 KOLL CENTER PARKWAY 200 PLEASANTON CA 94566 510155190 RETIREMENT CA 501(A) N/A NA false INT'L ASSOC OF HEAT & FROST LOCAL 5 670 EAST FOOTHILL BLVD UNIT 2 AZUSA CA 91702 950866519 LABOR UNION CA 501(C)(5) N/A NA false INT'L ASSOC OF HEAT & FROST LOCAL 7 14675 INTERURBAN AVE S 103 TUKWILA WA 98168 910405896 LABOR UNION WA 501(C)(5) N/A NA false HEAT & FROST INSULATORS LOCAL 16 3801 PARK RD BENICIA CA 94510 940577197 LABOR UNION CA 501(C)(5) N/A NA false INT'L ASSOC OF HEAT & FROST LOCAL 28 6210 CARR STREET ARVADA CO 80004 840339764 LABOR UNION CO 501(C)(5) N/A NA false HEAT & FROST INSULATORS & ALLED WORKERS 11145 NE SANDY BLVD PORTLAND OR 97220 930115033 LABOR UNION OR 501(C)(5) N/A NA false ALLIED WORKER AFL-CIO LOCAL 73 1841 NORTH 24TH STREET 7 PHOENIX AZ 85008 860144013 LABOR UNION AZ 501(C)(5) N/A NA false INTL ASSOC OF HEAT & FROST LOCAL 76 422 ADAMS SE ALBUQUERQUE NM 87108 850091963 LABOR UNION NM 501(C)(5) N/A NA false ASBESTOS WORKERS LOCAL 82 3919 EAST MAIN AVENUE SPOKANE WA 99202 910617900 LABOR UNION WA 501(C)(5) N/A NA false ASBESTOS WORKERS AFL-CIO LOCAL 135 4316 E ALEXANDER ROAD LAS VEGAS NV 89115 880092338 LABOR UNION NV 501(C)(5) N/A NA false INTL ASSOC OF HEATASBESTOS WORKERS 2261 SOUTH REDWOOD ROAD SALT LAKE CITY UT 84119 870222439 LABOR UNION UT 501(C)(5) 5) N/A 5) NA false false false false false false false false false false false false false false false false false false false false 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, 2022, THERE ARE APPROXIMATELY 73 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. A P I INC A1 INSULATION MECHANICAL, LLC AARC-WEST MECHANICAL INSULATION (USA), LLC ACE MECHANICAL INSULATION, INC AIS, INC. ALBUQUERQUE INSULATION APACHE INDUSTRIAL UNITED, INC ARGUS CONTRACTING, LLC ARIZONA HEAT & FROST APPRENTICESHIP TRAINING TRUST ARK PREMIUM CONSTRUCTION LLC ASBESTOS LOCAL 7 ASBESTOS LOCAL 82 ASBESTOS LOCAL 82 JATC ATS WELDING INC BABCOCK & WILCOX CONST CO. LLC BARRACUDA INSULATION BOYTER BROTHERS BOYTER BROTHERS, LLC BRANDSAFWAY INDUSTRIES, LLC D & G MECHANICAL INSUL INC D2 SERVICES INC DKB INC. DKB, INC. EXCEL PACIFIC MECHANICAL INSUL. FARWEST INSULATION CONTRACTING FRONTIER INC. GLOBAL PACIFIC ENVIRONMENTAL INC HEAT & FROST INSUL APPRENTICE HEAT & FROST INSULATORS LOCAL 28 HEAT & FROST INSULATORS LOCAL 36 HEAT & FROST INSULATORS LOCAL 69 HEAT & FROST INSULATORS LOCAL 73 HEAT & FROST INSULATORS LOCAL 76 HECKMAN INC. HOLADAY-PARKS, INC. HUDSON BAY INSULATION CO IDAHO ENVIRONMENTAL COALITION LLC INTERMOUNTAIN SPECIALTY CONTRACTING J & J MECHANICAL INSULATION JEWEL MECHANICAL INSULATION LLC. JKAY, INC K FOX INSULATION INC KARBER MECHANICAL INSULATION KENNER MECHANICAL INSULATION L & L MECHANICAL, INC LIFE SAFETY SOLUTIONS LOS ALAMOS NATIONAL SECURITY LOUIS A ROSER COMPANY MECHANICAL INSULATING INC MID-VALLEY INSULATING, INC. NAES POWER CONTRACTORS NELSON INSULATION COMPANY-COLORADO PERFORMANCE CONTRACTING PERFORMANCE CONTRACTING GROUP PMI INC ROGUE MECHANICAL INSULATION SAFWAY SERVICES SAFWAY SERVICES INC SAFWAY SERVICES, LLC SEATTLE ASB WKRS JATC SEATTLE BUILDING & CONSTR SFS, INC SILVER FALLS INSULATION,LLC SOUTHWEST SPECIALTY CONTRACTORS LLC SUMMIT CONTRACTING, LLC THERMAX INSULATION, LLC TIMISCO MECHANICAL INSULATION LLC TOVIN INSULATION CONCEPTS VALLEY MECHANICAL INSULATION VMI-VALLEY MECHANICAL INSUL. INC WILLIAMS PLANT SERVICES, LLC WMC MECHANICAL YEAROUT SUPPORT SERVICES, LLC