2021-09-29T12:28:44-05:00 2020-11-30 542189926 Henningfield & Associates Inc 28296 Constellation Road Valencia CA 91355 990 2019-12-01 866052021 TEAMSTERS WESTERN REGION AND NEW JERSEY HEALTH CARE FUND TEAM 6022493582 2550 W UNION HILLS DRIVE SUITE 29 PHOENIX AZ 85027 DOUGLAS RUYGROK TRUSTEE 6022493582 2021-09-23 1 RANDY D HENNINGFIELD P01364367 6612953363 2019 2022-09-23 18:48:47Z DOUGLAS RUYGROK 450 CARSON PLAZA DRIVE CARSON CA 90746 1356607161 0 X N/A X 1950 AZ HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 8 8 0 0 0 0 0 0 810906707 891149256 68990793 65491859 24382208 29464233 904279708 986105348 0 0 585643477 604506201 0 0 0 0 0 33476202 34369859 619119679 638876060 285160029 347229288 1706259010 2169172532 70005000 84135630 1636254010 2085036902 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 604506201 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 604506201 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 1835 0 1 0 0 0 0 0 0 0 0 0 X 8 8 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 45000 0 0 ANDREW MARSHALL TRUSTEE 4.00 X 0 0 0 BJ DORFMAN 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 DANNY MA TRUSTEE 4.00 X 0 0 0 45000 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD AZ 8220 N 23RD AVENUE PHOENIX AZ 85021 PPO NETWORK / CLAIMS PROCESSING 12788518 AETNA PO BOX 14079 LEXINGTON KY 40512 PPO NETWORK / CLAIMS PROCESSING 7172725 SOUTHWEST SERVICE ADMINISTRATORS 2500 W UNION HILLS DRIVE STE 29 PHOENIX AZ 85027 CONTRACT ADMINISTRATOR 5060241 CAMDEN BONDS PLUS FUND 11111 SANTA MONICA BLVD STE 300 LOS ANGELES CA 90025 INVESTMENT MGMT 2097566 BILLER AND ASSOCIATES 535 MIDDLEFIELD RD STE 230 MENLO PARK CA 94025 INVESTMENT MGMT 1090326 23 EMPLOYER CONTRIB 480000 883602875 883602875 PARTICIPANT CONTRIB 480000 7546381 7546381 891149256 36929631 36929631 399064041 370501813 28562228 28562228 28562228 PRESCRIPTION REBATES 480000 29238247 29238247 RETIREE PRESCRIPTION SUBSIDY 480000 225986 225986 29464233 986105348 920613489 0 65491859 604506201 604506201 4060240 4060240 248244 248244 111485 111485 6846673 6846673 469427 469427 857385 857385 21719 21719 172106 172106 COST CONTAINMENT FEES 20309830 20309830 ADMINISTRATION - EXTERN 784874 784874 DISABILITY PAYROLL TAXE 279124 279124 PCORI FEES 173197 173197 35555 35555 638876060 604506201 34369859 0 -342370 8469953 100982835 76310773 117111 174213 1605501434 2084217593 1706259010 2169172532 8254899 7350179 489745 565280 61260356 76220171 70005000 84135630 X 0 0 0 0 1636254010 2085036902 1636254010 2085036902 1706259010 2169172532 347229288 101553604 0 X 0 1 X 1 0 0 CLAIMS PAYABLE AND IBNR 80697000 PREMIUMS PAYABLE -4476829 76220171 1081902605 101553604 101553604 980349001 5756347 5756347 986105348 618159898 0 618159898 5756347 14959815 20716162 638876060 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. B.J. DORFMAN - 55 GLENLAKE PKWY, ATLANTA, GA 30328. 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. DANNY MA - 20227 N 27TH AVENUE, PHOENIX, AZ 85027. 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