2022-05-20T16:16:26-05:00 2021-07-31 222027092 WITHUMSMITHBROWN PC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2020-08-01 686097704 TEAMSTERS RETIREE TRUST TEAM 2099488483 PO BOX 2300 STOCKTON CA 95201 DAVE HAWLEY TRUSTEE 2099488483 2022-05-20 1 DAVE HAWLEY 999009999 JOSEPH M THIERMANN P01066616 9252779100 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAVE HAWLEY PO BOX 2300 STOCKTON CA 95201 53229352 0 X N/A X 1993 CA TO PROVIDE HEALTH BENEFITS FOR PARTICIPANTS AND THEIR DEPENDENTS. 5 0 0 0 0 0 0 0 27030184 30904313 -112210 1303935 0 0 26917974 32208248 0 0 24966534 31280639 0 0 0 0 0 1877756 1933776 26844290 33214415 73684 -1006167 18645104 24327491 3886976 10772214 14758128 13555277 TO PROVIDE HEALTH AND WELFARE BENEFITS FOR RETIRED EMPLOYEES AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS FOR RETIRED EMPLOYEES AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 5 0 1 0 0 0 0 0 0 0 0 0 X 5 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X DELTA FUND ADMINISTRATORS 2099405100 1234 W OAK STREET STOCKTON CA 95203 X MIKE CARNEFIX TRUSTEE 0.50 X 0 0 0 DAVE HAWLEY TRUSTEE 0.50 X 0 0 0 JEFF BERDION TRUSTEE 0.50 X 0 0 0 PETER NUNEZ TRUSTEE 0.50 X 0 0 0 ALLEN CHEEK TRUSTEE 0.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 1 0 0 1 0 0 0 0 0 DELTA FUND ADMINISTRATORS LLC 1234 WEST OAK STREET STOCKTON CA 95203 CONTRACT ADMINISTRATOR 1166504 ANTHEM BLUE CROSS 2121 N CALIFORNIA BLVD WALNUT CREEK CA 94956 CONTRACT ADMINISTRATOR 188089 DELTA HEALTH SYSTEMS 3244 BROOKSIDE ROAD STOCKTON CA 95219 CONTRACT ADMINISTRATOR 172724 WELLDYNE RX 500 EAGLES LANDING DR LAKELAND FL 33810 CONTRACT ADMINISTRATOR 130519 4 RESERVE SUBSIDY 900099 14752442 14752442 RETIREE & EMPLOYER CONTRIBUTIONS 900099 7631821 7631821 ACTIVE SUBSIDY 900099 7402833 7402833 DRUG REBATE 900099 562962 562962 STOP-LOSS REIMBURSEMENT 900099 498625 498625 55630 55630 30904313 326106 326106 21998933 21021104 977829 977829 977829 32208248 30904313 0 1303935 31280639 1225897 19785 36900 38419 547414 48741 16620 33214415 5106775 3117098 1151245 6351575 3386 12387084 14855432 18645104 24327491 52115 159028 472959 221102 3361902 10392084 3886976 10772214 X 0 0 0 0 14758128 13555277 14758128 13555277 18645104 24327491 -1006167 -196684 0 X X 0 1 X 1 0 0 BENEFIT OBLIGATIONS 4811241 DUE TO BROKER FOR SECURITIES PURCHASED 5580843 10392084 X 31973145 -196684 -196684 32169829 38419 38419 32208248 31726657 0 31726657 38419 1449339 1487758 33214415 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF JULY 31, 2021, 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 BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2018. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE GOVERNING BODY HAS APPOINTED MANAGEMENT DUTIES TO A THIRD-PARTY ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN DOES NOT HAVE A COMMITTEE TO ACT WITH AUTHORITY ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED WITH A COPY OF THE FORM 990 PRIOR TO BEING FILED. THE PLAN'S ADMINISTRATOR IS RESPONSIBLE FOR CONDUCTING A DETAILED REVIEW OF THE FORM 990 PRIOR TO IT BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT-OF-INTEREST POLICY APPLIES TO ALL TRUSTEES AS WELL AS ANY OTHER INDIVIDUALS WHO EXERCISE DISCRETIONARY AND/OR FIDUCIARY AUTHORITY OVER THE AFFAIRS OF THE TRUST, AND THE POLICY IS REGULARLY AND CONSISTENTLY MONITORED AND ENFORCED BY THE ORGANIZATION BY REQUIRING THE TRUSTEES TO ANNUALLY DISCLOSE TO THE BOARD ANY CONFLICTS OF INTEREST. THE BOARD HAS DISCRETIONARY AUTHORITY TO DETERMINE WHETHER THE TRANSACTION IS IN THE BEST INTEREST OF THE TRUST. SUCH DETERMINATIONS ARE TO BE MADE WITHOUT THE INPUT OR PARTICIPATION OF THE CONFLICTED INDIVIDUALS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT COMPENSATE TRUSTEES. 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 VII, SECTION A, LINE 7A TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER 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, DELTA FUND ADMINISTRATOR SERVICES, LLC. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. NORTHERN CALIFORNIA GENERAL TEAMSTERS SECURITY FUND PO BOX 2300 STOCKTON CA 95201 946073033 TO PROVIDE HEALTH AND WELFARE BENEFITS. CA 501C(9) N/A N/A 0 TEAMSTERS LOCAL UNION 948 1933 W CALDWELL VISALIA CA 93277 941310598 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 137 3540 S MARKET REDDING CA 96001 940577278 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 150 7120 E PARKWAY SACRAMENTO CA 95823 940380120 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 386 1225 THIRTEENTH ST MODESTO CA 95354 940577279 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 431 1140 W OLIVE STREET FRESNO CA 93278 940577293 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 439 PO BOX 1611 STOCKTON CA 95201 940918920 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 517 512 W OAK ST VISALIA CA 93291 941069921 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 533 240 GENRTY WAY RENO NV 89502 880046825 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 TEAMSTERS LOCAL UNION 87 2531 G STREET BAKERSFIELD CA 93301 950865989 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION. CA 501C(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R, PART VII, SUPPLEMENTAL INFORMATION THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF JULY 31, 2021, THERE ARE APPROXIMATELY 6 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. SILIGAN CAN CO KRAFT HEINZ CO MODOC JT UNI SCH DISTRICT CASCADE UNION ELEM POST HOLDINGS, INC. DELTA HEALTH SYSTEMS