2023-09-14T11:27:40-05:00 2022-11-30 542189926 Henningfield & Associates Inc 28296 Constellation Road Valencia CA 91355 990 2021-12-01 866052021 TEAMSTERS WESTERN REGION AND NEW JERSEY HEALTH CARE FUND TEAM 6022493582 2550 W UNION HILLS DRIVE SUITE 29 PHOENIX AZ 85027 ANDREW MARSHALL TRUSTEE 6022493582 2023-09-03 1 ANDREW MARSHALL 999009999 RANDY D HENNINGFIELD P01364367 6612953363 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ANDREW MARSHALL 450 CARSON PLAZA DRIVE CARSON CA 90746 1572573530 0 X N/A X 1950 AZ HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 9 9 0 0 0 0 0 0 1015794797 1082533188 54915882 96991369 34093055 45180081 1104803734 1224704638 0 0 691423449 752298738 0 0 0 0 0 41657051 45232862 733080500 797531600 371723234 427173038 2785434314 2901404610 99951056 94428984 2685483258 2806975626 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 752298738 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 752298738 0 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 1 1769 0 1 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X SOUTHWEST SERVICE ADMINISTRATORS 6022493582 2550 W UNION HILLS DRIVE STE 290 PHOENIX AZ 85027 KARLA SCHUMANN TRUSTEE 4.00 X 0 0 0 DOUGLAS RUYGROK TRUSTEE 15.00 X 45100 0 0 ANDREW MARSHALL TRUSTEE 4.00 X 0 0 0 ANTHONY DECOSMO TRUSTEE 4.00 X 0 0 0 CHRIS LANGAN TRUSTEE 4.00 X 0 0 0 ALFRED BETTS TRUSTEE 4.00 X 0 0 0 MARK DAVISON TRUSTEE 4.00 X 0 0 0 BRIAN PERSON TRUSTEE 4.00 X 0 0 0 CHRIS ELTZHOLTZ TRUSTEE 4.00 X 0 0 0 45100 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD AZ 8220 N 23RD AVENUE PHOENIX AZ 85021 PPO NETWORK / CLAIMS PROCESSING 15099511 AETNA 4500 E COTTON CENTER BLVD PHOENIX AZ 85040 PPO NETWORK / CLAIMS PROCESSING 8251889 SOUTHWEST SERVICE ADMINISTRATORS 2500 W UNION HILLS DRIVE STE 29 PHOENIX AZ 85027 CONTRACT ADMINISTRATOR 4935886 CAMDEN BONDS PLUS FUND 11111 SANTA MONICA BLVD STE 300 LOS ANGELES CA 90025 INVESTMENT MGMT 4566731 BILLER AND ASSOCIATES 535 MIDDLEFIELD RD STE 230 MENLO PARK CA 94025 INVESTMENT MGMT 1554399 28 EMPLOYER CONTRIB 480000 1072672606 1072672606 PARTICIPANT CONTRIB 480000 9860582 9860582 1082533188 40485760 40485760 404374501 347868892 56505609 56505609 56505609 PRESCRIPTION REBATES 480000 44458126 44458126 RETIREE PRESCRIPTION SUBSIDY 480000 433812 433812 COBRA SUBSIDY INCOME 480000 205541 205541 82602 82602 45180081 1224704638 1127713269 0 96991369 752298738 752298738 4935886 4935886 269625 269625 242881 242881 13020102 13020102 503885 503885 1169628 1169628 90412 90412 208100 208100 COST CONTAINMENT FEES 23639438 23639438 ADMINISTRATION - EXTERN 593215 593215 DISABILITY PAYROLL TAXE 308551 308551 PCORI FEES 211621 211621 39518 39518 797531600 752298738 45232862 0 18058752 49176088 86755798 93257007 155488 137786 2680464276 2758833729 2785434314 2901404610 5185770 3263408 657029 739185 94108257 90426391 99951056 94428984 X 0 0 0 0 2685483258 2806975626 2685483258 2806975626 2785434314 2901404610 427173038 -305680670 0 X 0 1 X 1 0 0 CLAIMS PAYABLE AND IBNR 97635000 PREMIUMS PAYABLE -7208609 90426391 907558265 -305680670 -305680670 1213238935 11465703 11465703 1224704638 789747763 0 789747763 11465703 -3681866 7783837 797531600 Part XII, Line 4b - Other Adjustments: CHANGES IN CLAIMS PAYABLE AND IBNR CHANGE IN PREMIUMS PAYABLE Form 990, Part VI, Section A, line 3 THE TRUSTEES HAVE CONTRACTED WITH A THIRD PARTY ADMINISTRATOR TO PERFORM THE EVERYDAY ADMINISTRATION OF THE FUND. Form 990, Part VI, Section B, line 11b A COPY OF FORM 990 WAS PRESENTED TO THE TRUSTEES FOR REVIEW AND SIGNATURES. Form 990, Part VI, Section B, line 12c MONITORING AND ENFORCEMENT OF CONFLICT OF INTEREST POLICY IS APPROVED ANNUALLY AT BOARD OF TRUSTEES MEETING. Form 990, Part VI, Section C, line 19 SUMMARY ANNUAL REPORTS ARE PROVIDED TO ALL PARTICIPANTS ANNUALLY. SPDS ARE AVAILABLE VIA WEBSITE AND FROM THE ADMINISTRATOR UPON REQUEST. AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY REQUEST OF THE DOL OR ADMINISTRATION. Form 990, Part VII Contact Addresses for Officers, Directors, Etc KARLA SCHUMANN - 1450 S 27TH STREET, PHOENIX, AZ 85009. DOUGLAS RUYGROK - 2102 LA CANADA CREST DRIVE, LA CANADA, CA 91011. ANDREW MARSHALL - 450 CARSON PLAZA DRIVE, CARSON, CA 90746. ANTHONY DECOSMO - 6900 S YOSEMITE ST, CENTENNIAL, CO 80012. CHRIS LANGAN - 2618 CORRAL DR, CELINA, TX 75009. ALFRED BETTS - 282 HILLSIDE AVE, HILLSIDE, NJ 07205. MARK DAVISON - 1850 NE 162ND AVENUE, PORTLAND, OR 97230. BRIAN PERSON - 55 GLENLAKE PKWY, ATLANTA, GA 30328. CHRIS ELTZHOLTZ - 282 HILLSIDE AVE, HILLSIDE, NJ 07205. 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