2022-08-04T10:13:26-05:00 2021-10-31 542189926 Henningfield & Associates Inc 28296 Constellation Road Valencia CA 91355 990 2020-11-01 946330971 NORTHERN CALIFORNIA SOFT DRINK INDUSTRY & TEAMSTERS HEALTH AND WELFARE TRUST FND NORT 9258334353 4160 DUBLIN BLVD No 400 DUBLIN CA 94568 DENNIS HART TRUSTEE 9258334353 2022-08-02 1 DENNIS HART 999009999 RANDY D HENNINGFIELD P01364367 6612953363 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z DENNIS HART 7750 PARDEE LANE OAKLAND CA 94621 35902527 0 X N/A X 1972 CA PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 8 8 0 0 0 0 0 0 10332549 14927303 513517 825591 0 1991428 10846066 17744322 0 0 13042891 14731967 0 0 0 0 0 848128 920856 13891019 15652823 -3044953 2091499 17415644 19333811 40776 15566 17374868 19318245 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE UNION AND EMPLOYERS. 0 0 15652823 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE UNION AND EMPLOYERS. 15652823 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 X 8 8 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 CA X MR MATT CLIZBE 9258334353 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94568 X JEFF CARLSEN TRUSTEE 5.00 X 0 0 0 CHRIS LOPEZ TRUSTEE 5.00 X 0 0 0 PENNY SCHUMACHER TRUSTEE 5.00 X 0 0 0 ROBIN USSERY TRUSTEE 5.00 X 0 0 0 JESSE CASQUEIRO TRUSTEE 5.00 X 0 0 0 DENNIS HART TRUSTEE 5.00 X 0 0 0 MARK HAWKINS TRUSTEE 5.00 X 0 0 0 BRIAN INDELICATO TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 HEALTH SERVICES & BENEFIT ADMINISTRATORS 4160 DUBLIN BLVD STE 400 DUBLIN CA 94568 ADMINISTRATOR 247200 SEYFARTH SHAW 2029 CENTURY PARK EAST STE 3500 LOS ANGELES CA 90067 LEGAL 149914 ANTHEM BLUE CROSS 11050 OLSON DRIVE STE 110 RANCHO CORDOVA CA 95670 CLAIMS ADMINISTRATOR 134575 3 EMPLOYER CONTRIBUTIONS 900099 14899200 14899200 PARTICIPANT CONTRIBUTIONS 900099 28103 28103 14927303 316260 316260 18667536 18158205 509331 509331 509331 STOP LOSS RECOVERIES 900099 1527575 1527575 PRESCRIPTION DRUG REBATES 900099 455636 455636 COBRA SUBSIDY 900099 8217 8217 1991428 17744322 16918731 0 825591 14731967 14731967 247200 247200 219889 219889 17720 17720 91995 91995 27500 27500 9550 9550 1317 1317 18698 18698 ANTHEM BLUE CROSS 124255 124255 BENEFIT CONSULTANTS 94842 94842 T.A.P. PROGRAM 21097 21097 PRINTING AND POSTAGE 13541 13541 33252 33252 15652823 15652823 0 0 2162816 2663245 1916816 1502345 1265 0 13334747 15168221 17415644 19333811 40776 15566 40776 15566 X 0 0 0 0 17374868 19318245 17374868 19318245 17415644 19333811 2091499 -148122 0 X X 0 1 X 1 0 0 X 17504205 -148122 -148122 17652327 91995 91995 17744322 15560828 0 15560828 91995 91995 15652823 Part X, Line 2: The trust has adopted guidance on accounting for uncertainty in income taxes issued by the Financial Accounting Standards Board. The Trust's management believes that the trust has not taken certain tax positions that require adjustment to the financial statements as a tax liability. Informational tax returns, for tax years for which the applicable statutes of limitations have not expired, are subject to examiniation by authorities. Form 990, Part VI, Section A, line 3 The organization has delegated control over management duties customarily performed by or under the direct supervision of officers, directors, trustees, or key employees to a contract administrator, Health Services & Benefit Administrators. Form 990, Part VI, Section A, line 8b The organization does not have sub-committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b Trustees are emailed the form and asked to remark if they have changes. Form 990, Part VI, Section B, line 12c Trustees review & re-sign the policy annually. Form 990, Part VI, Section C, line 19 The organication makes its governing document, conflict of interest policy, and financial statements available to the public upon request. Summary Annual Reports are provided to all participants annually. SPD's and audited financial statements are available from the administrator upon request, as well as the DOL website. Form 990, Part VII Contact Addresses for Officers, Directors, Etc JEFF CARLSEN - 6250 N. RIVER ROAD, STE 9000, ROSEMONT, IL 60018. CHRIS LOPEZ - 1300 W. TAFT AVENUE, ORANGE, CA 92865. PENNY SCHUMACHER - 5918 STONERIDGE MALL, PLEASANTON, CA 94588. ROBIN USSERY - 6250 N. RIVER ROAD, STE 9000, ROSEMONT, IL 60018. JESSE CASQUEIRO - 7750 PARDEE LANE, OAKLAND, CA 94621. DENNIS HART - 7750 PARDEE LANE, OAKLAND, CA 94621. MARK HAWKINS - 400 ROLAND WAY, OAKLAND, CA 94621. BRIAN INDELICATO - 301 GEORGIA STREET, STE 220, VALLEJO, CA 94590. Form 990, Part XII, Line 2c: The Board of Trustees assumes responsibility for the oversight of the audit of the organization's financial statements and the selection of independent auditor. TEAMSTERS LOCAL 853 7750 PARDEE LANE OAKLAND CA 94621 940963930 LABOR UNION CA 501(C)(5) 0 TEAMSTERS LOCAL 70 400 ROLAND WAY OAKLAND CA 94621 LABOR UNION CA 501(C)(5) 0 TEAMSTERS LOCAL 896 301 GEORGIA STREET STE 220 VALLEJO CA 94590 951498604 LABOR UNION CA 501(C)(5) 0 REYES HOLDINGS LLC 6250 N RIVER ROAD STE 9000 ROSEMONT IL 60018 364121934 BEVERAGE DISTRIBUTION IL C 0 KEURIG DR PEPPER 1300 W TAFT AVENUE ORANGE CA 92865 BEVERAGE DISTRIBUTION CA C 0 SAFEWAY NORTHERN CALIFORNIA DIVISION 5918 STONERIDGE MALL PLEASANTON CA 94588 BEVERAGE DISTRIBUTION CA C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0