2022-05-20T16:31:23-05:00 2021-07-31 222027092 WITHUMSMITHBROWN PC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2020-08-01 946073033 NORTHERN CALIFORNIA GENERAL TEAMSTERS SECURITY FUND NORT 2099405100 PO BOX 2300 STOCKTON CA 95201 DAVE HAWLEY TRUSTEE 2099405100 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 877619331 0 X N/A X 1952 CA TO PROVIDE HEALTH & WELFARE BENEFITS. 5 0 0 0 0 0 0 0 332032307 365893860 -759782 49563819 0 0 331272525 415457679 0 0 266332699 276306364 0 0 0 0 0 33686499 38587450 300019198 314893814 31253327 100563865 414181500 557118545 73135399 116706463 341046101 440412082 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 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 8 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 JEFF BERDION TRUSTEE 1.00 X 0 0 0 PETER NUNEZ TRUSTEE 1.00 X 0 0 0 MIKE CARNEFIX TRUSTEE 1.00 X 0 0 0 ALLEN CHEEK TRUSTEE 1.00 X 0 0 0 DAVE HAWLEY TRUSTEE 1.00 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 W OAK STREET STOCKTON CA 95207 CONTRACT ADMINISTRATOR 8067768 ANTHEM BLUE CROSS 2121 N CALIFORNIA BLVD WALNUT CREEK CA 94596 NETWORK FEES 3572863 MCMORGAN & COMPANY ONE FRONT STREET STE 500 SAN FRANCISCO CA 94111 INVESTMENT MANAGER 758518 CYPRESS DENTAL ADMINISTRATORS 3244 BROOKSIDE ROAD STOCKTON CA 95219 CONTRACT ADMINISTRATOR 687370 WELLDYNERX INC 500 EAGLES LANDING DR LAKELAND FL 33810 CONTRACT ADMINISTRATOR 598090 11 EMPLOYER CONTRIBUTIONS 900099 354768457 354768457 PRESCRIPTION REBATES 900099 6296528 6296528 STOP LOSS REIMBURSEMENT 900099 3584294 3584294 PARTICIPANT CONTRIBUTIONS 900099 754444 754444 OTHER REVENUE 900099 490137 490137 365893860 17507141 17507141 494218330 462161652 32056678 32056678 32056678 415457679 365893860 0 49563819 276306364 8219525 113103 205317 2004194 5480011 317593 92432 RESERVE SUBSIDIES PAID 14752442 RETIREE SUBSIDIES PAID 7402833 314893814 40135545 38014447 33114597 72043365 19056 35561 340912302 434785169 12240003 414181500 557118545 6469674 45681537 2800000 1750000 63865725 69274926 73135399 116706463 X 0 0 0 0 341046101 440412082 341046101 440412082 414181500 557118545 100563865 -1197884 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE AND IBNR 43921926 ACCUMULATED ELIGIBILITY CREDITS 25353000 69274926 X 412255601 -1197884 -1197884 413453485 2004194 2004194 415457679 306762969 0 306762969 2004194 6126651 8130845 314893814 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 ORGANIZATION DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS MADE AVAILABLE TO EACH OF THE TRUSTEES FOR REVIEW BEFORE THE RETURN WAS FILED. THE THIRD-PARTY ADMINISTRATOR REVIEWED THE FORM FOR COMPLETENESS AND ACCURACY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT-OF-INTEREST POLICY COVERS ALL TRUSTEES AND ANY OTHER INDIVIDUALS WHO EXERCISE DISCRETIONARY AND/OR FIDUCIARY AUTHORITY OVER THE AFFAIRS OF THE TRUST. AT LEAST ONCE ANNUALLY, TRUSTEES AND OTHER FIDUCIARIES ARE REQUIRED TO DISCLOSE IN WRITING ANY RELATIONSHIPS OR INTERESTS THAT COULD GIVE RISE TO A CONFLICT. THE BOARD HAS DISCRETIONARY AUTHORITY TO DETERMINE WHETHER A CONFLICT DOES IN FACT, EXIST AND, IF SO, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR AND REASONABLE TO THE TRUST. SUCH DETERMINATIONS ARE MADE WITHOUT THE INPUT OR PARTICIPATION OF THE CONFLICTED INDIVIDUAL. 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 9A: 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 ADMINISTRATORS LLC. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. TEAMSTERS RETIREE TRUST PO BOX 2330 STOCKTON CA 95201 686097704 TO PROVIDE HEALTH BENEFITS FOR RETIRED PARTICIPANTS AND THEIR DEPENDENTS. CA 501(C)(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 GENTRY WAY RENO NV 89502 880046825 LOCAL UNION/SPONSORING ORGANIZATION OF THE FILING ORGANIZATION NV 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 TEAMSTERS LOCAL UNION 601 745 EAST MINER AVENUE STOCKTON CA 95202 940366146 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, 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 JULY 31, 2021, THERE ARE APPROXIMATELY (OPEN) 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. ORLAND UNIT WATER USERS ASSOC AGGREGATE PRODUCTS FOSTER FARMS - FRESNO ADVANCED FOOD PRODUCTS ALLIED/ REPUBLIC WASTE STKN ALLIED/ REPUBLIC WASTE STKN ALLIED/ REPUBLIC WASTE STKN SYSCO FOOD SERVICE OF SAC GRANITE CONSTRUCTION WILBUR-ELLIS CO GRANITE ROCK GREIF INDUSTRIAL GEORGE KISHIDA INC AMERIPRIDE UNIFORM SER - FRESNO AMERIPRIDE UNIFORM SER - SAC WESTWAY FEED PRODUCTS RUAN - T321 TRUCKLOAD RUAN - T317 RUAN - T309 TANK ANDERSON / COTTONWOOD A-C IRRIGATION DISTRICT CA DAIRIES - TURLOCK VULCAN MATERIALS (PREV CALMAT) ARAMARK ASTA CONSTRUCTION SAPUTO DAIRY FOODS BAKER COMMODITIES. INC BALL METAL FOOD CONTAINERS BARRETO & SILVEIRA DAIRY LAND O LAKES CARDINAL LOGISTICS MGMT LAND O LAKES, INC. LAS ANIMAS CONCRETE INLAND BIG 4 TIRE SERVICE BERKELEY FARMS BLACK BUTTE SCHOOL DIST BREAKTHRU BEVERAGE NEVADA ORGANIZED LABOR CREDIT UNION ALLIED WASTE / FRESNO ALLIED WASTE / RICE RD BUCHWALD'S CA COLD STORAGE CALAVERAS TRANSIT MIX RUAN - T305 C.A.S.E. 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RIDER & SONS HAPPY VALLEY SCHOOL DIST JIM HYATT PRODUCE LEEP/TESCHER/HELFMAN/ZANZE KNAUF INSULATION SOUTHERN WINE & SPIRITS LEPRINO FOODS - TRACY LEPRINO FOODS - LEMOORE LOCAL 948 LOCAL 137 LOCAL 150 / OFFICE T&T TRUCK AND CRANE LOCAL 386 LOCAL 431 LOCAL 439 LOCAL 533 LOCAL 517 LEWISTON ELEM SCHOOL DIST CEMEX CEMEX CEMEX / MERCED PLANT CEMEX CEMEX / MODESTO, NEWMAN, TURLOCK CA DAIRIES - LOS BANOS S. 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SUGAR TRANSPORT CALAVERAS MATERIALS SURPRISE VALLEY SCHOOL / CERTIFIED TAHOE TRANSIT DISTRICT T.A.R.P. SUNSWEET GROWERS TEICHERT AGGREGATES SAVE MART COMPANIES TIN MAN DENTAL SUPPLY TRANSDEV CHICO TRANSDEV REDDING RAIL TERMINAL SERVICES US COLD STORAGE VALLEY FIG - UNION AMERIPRIDE UNIFORM SER -FRESNO WAYSIDE LUMBER WILLIAMS BAKERY/ US BAKERY WESTERN BUILDING MATERIALS VARCITY ICE CREAM DISTRICT VEGETABLE GROWERS SUPPLY INC LOCAL 87 UPS - VARIOUS LOCATIONS