2024-04-11T07:35:20-05:00 2023-05-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2022-06-01 204570305 SEIU LOCAL 2015 LONG-TERM CARE WORKERS HEALTH TRUST SEIU 8776985829 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 DAVID WERLIN TRUSTEE 8776985829 2024-04-10 1 DAVID WERLIN XXX-XX-XXXX 1 KRISTIN A JACQUELIN CPA P01325865 2023319880 2024-04-11 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID WERLIN 2910 BEVERLY BOULEVARD LOS ANGELES CA 90057 23395953 0 X N/A X 2006 CA THE TRUST WAS ESTABLISHED TO MAINTAIN THE LONG TERM CARE WORKERS HEALTH PLAN. THE PLAN WAS CREATED FOR THE EXCLUSIVE BENEFIT OF ELIGIBLE LONG TERM CARE WORKERS. THE PLAN PROVIDES HEALTH BENEFITS (MEDICAL, DENTAL, AND VISION) TO PARTICIPATING EMPLOYEES IN THE IN-HOME SUPPORTIVE SERVICES INDUSTRY OF CALIFORNIA, WHOSE EMPLOYERS ARE REQUIRED, BY CONTRACT, TO PAY CONTRIBUTIONS TO THE TRUST. 3 0 0 0 0 0 0 0 9533091 10719972 886265 417286 30084 66379 10449440 11203637 0 0 9301323 10574379 0 0 0 0 0 210417 186029 9511740 10760408 937700 443229 13464655 13320395 20783 3272 13443872 13317123 SEE SCHEDULE O FOR DETAILS. 0 0 THE PLAN PROVIDES HEALTH BENEFITS SUCH AS MEDICAL, DENTAL, AND VISION TO PARTICIPATING EMPLOYEES IN THE IN-HOME SUPPORTIVE SERVICES INDUSTRY OF CALIFORNIA. 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 CA X DELTA FUND ADMINISTRATORS LLC 2099405100 1234 WEST OAK STREET STOCKTON CA 95203 CSEKEY TOM TRUSTEE 1.00 40.00 X 0 163174 44111 WERLIN DAVID CHAIR 1.00 40.00 X 0 175638 55096 CULBREATH FAITH TRUSTEE 1.00 40.00 X 0 184572 41645 0 523384 140852 0 0 1 0 0 EMPLOYEE CONTRIBUTIONS 900099 10529560 10529560 EMPLOYER CONTRIBUTIONS 900099 190412 190412 10719972 443657 443657 12165945 12192316 -26371 -26371 -26371 66379 66379 66379 11203637 10786351 0 417286 10574379 15372 21000 47933 2348 24187 ADMINISTRATOR FEES 75189 10760408 269902 194198 91081 131117 5434 5586 12271054 12113954 827184 875540 13464655 13320395 20783 3272 20783 3272 X 13443872 13317123 13443872 13317123 13464655 13320395 443229 -569978 0 X X 0 1 X 1 0 0 DUE FROM SEIU LOCAL 2015 875540 875540 X 10627686 -569978 -569978 11197664 5973 5973 11203637 10754435 0 10754435 5973 5973 10760408 PART X, LINE 2: THE PLAN IS INTENDED TO QUALIFY UNDER SECTION 501(C) (9) OF THE INTERNAL REVENUE CODE AND,THEREFORE, IS NOT SUBJECT TO INCOME TAX. THE PLAN OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE ON JANUARY 4, 2008, STATING THAT THE PLAN, AS THEN DESIGNED,WAS IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THE PLAN HAS ALSO RECEIVED A FAVORABLE TAX DETERMINATION LETTER FROM THE STATE OF CALIFORNIA. THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTERS. THE PLAN SPONSOR BELIEVES THAT THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION FOR FEDERAL OR CALIFORNIA INCOME TAXES HAS BEEN INCLUDED IN THE PLANS FINANCIAL STATEMENTS. AS OF MAY 31, 2023, THE STATUTE OF LIMITATIONS FOR TAX YEARS 2019 THROUGH 2021 REMAINS OPEN WITH THE U. S. FEDERAL JURISDICTION AND THE VARIOUS STATES AND LOCAL JURISDICTIONS IN WHICH THE PLAN FILES RETURNS. 0 0 0 WERLIN DAVID CHAIR 0 154445 0 9299 0 11894 0 32433 0 22663 0 230734 0 0 CULBREATH FAITH TRUSTEE 0 163777 0 9299 0 11496 0 34393 0 7252 0 226217 0 0 CSEKEY TOM TRUSTEE 0 140986 0 8423 0 13765 0 29607 0 14504 0 207285 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES REVIEW THE FORM 990 BEFORE FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C INTERNAL PROCEDURES INCLUDE THE CONTINUOUS REVIEW OF PROCEDURES TO ENSURE COMPLIANCE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THESE DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEARS. SEIU LOCAL 2015 2910 BEVERLY BLVD LOS ANGELES CA 90057 474164197 UNITE MEMBERS INTO ONE ORG. FOR THE PURPOSE OF IMPROVING WORKING CONDITIONS CA 501(C)(5) 0 COUNTY OF SAN BENITO - STATE OF CALIFORNIA SEIU UNITED LONG-TERM CARE WORKERS LOCAL UNION NO 6434 2910 BEVERLY BLVD LOS ANGELES CA 90057 260718017 UNITE MEMBERS INTO ONE ORG. FOR THE PURPOSE OF IMPROVING WORKING CONDITIONS CA 501(C)(5) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1