2020-09-30T15:43:55-05:00 2019-12-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2019-01-01 956048844 TEAMSTERS AND FOOD EMPLOYERS SECURITY TRUST FUND TEAM 6266461075 1050 LAKES DRIVE SUITE 120 WEST COVINA CA 91790 RICK MIDDLETON TRUSTEE 6266461075 2020-09-30 1 RANDY D HENNINGFIELD P01364367 6612953363 198.72.137.241 2020-09-30 12:23:29 PD P ED07B1E9E66BA0EF5981C867B3B832C67439175D ED07B1E9E66BA0EF5981C867B3B832C67439175D 2019 2021-04-22 16:20:28Z RICK MIDDLETON 450 CARSON PLAZA DRIVE CARSON CA 90746 145067435 0 X N/A X 1950 CA HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 6 6 0 0 0 0 0 0 136111323 133685750 490529 629872 3374228 7999653 139976080 142315275 0 0 132521246 145695483 0 0 0 0 0 6097387 6722289 138618633 152417772 1357447 -10102497 50617623 42358660 10933367 12431807 39684256 29926853 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 0 0 152417772 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 152417772 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 1457 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 CA X X MR BARRY OSHAROW 6266461090 1050 LAKES DRIVE SUITE 120 WEST COVINA CA 91790 X BRENT BOHN TRUSTEE 10.00 X 0 0 0 FRANK AFOA TRUSTEE 10.00 X 0 0 0 RICK MIDDLETON TRUSTEE 10.00 X 0 0 0 ERIC TATE TRUSTEE 10.00 X 0 0 0 DUANE SNIDER TRUSTEE 10.00 X 0 0 0 LEROY WESTMORELAND TRUSTEE 10.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS ADMINISTRATORS 1050 LAKES DR SUITE 120 WEST COVINA CA 91790 CONTRACT ADMINISTRATION 2912802 BROADREACH MEDICAL RESOURCES 1350 BROADWAY SUITE 410 NEW YORK NY 10018 CLAIMS PROCESSING 1845920 ANTHEM BLUE CROSS 11030 WHITE ROCK ROAD RANCHO CORDOVA CA 95670 NETWORK ACCESS FEES 376720 PART D ADVISORS INC 17199 N LAUREL PARK DRIVE STE 400 LIVONIA MI 48152 COST CONTAINMENT FEES 329457 SEYFARTH SHAW 2029 CENTURY PARK EAST STE 3500 LOS ANGELES CA 90067 LEGAL 155748 7 EMPLOYER CONTRIBUTIONS 445100 126376712 126376712 RETIREE CONTRIBUTIONS 445100 7018549 7018549 COBRA CONTRIBUTIONS 445100 290489 290489 133685750 632032 632032 2750000 2752160 -2160 -2160 -2160 PRESCRIPTION REBATES 445100 5554592 5554592 STOP LOSS RECOVERIES 445100 1694810 1694810 RETIREE PRESCRIPTION SUBSIDY 445100 750251 750251 7999653 142315275 141685403 0 629872 145695483 145695483 2950076 2950076 266200 266200 24000 24000 214604 214604 12078 12078 53302 53302 ADMINISTRATION - RX 1845919 1845919 PPO NETWORK 550165 550165 PART D ADVISORS INC 329457 329457 CONSULTANTS 274712 274712 201776 201776 152417772 152417772 0 0 14005179 6944208 5457355 6034139 36737 36994 31118352 29343319 50617623 42358660 282300 282400 10651067 12149407 10933367 12431807 X 0 0 0 0 39684256 29926853 39684256 29926853 50617623 42358660 -10102497 345094 0 X 0 1 X 1 0 0 PREMIUMS PAYABLE, IBNR AND ACCUMULATED ELIG. 11483985 DEFERRED RETIREE CONTRIBUTIONS 665422 12149407 142660369 345094 345094 142315275 0 142315275 150888384 0 150888384 1529388 1529388 152417772 Part XII, Line 4b - Other Adjustments: CHANGE IN PREMIUMS PAYABLE, IBNR & ACCUM. ELIGIBILITY 1,529,388. 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 C, line 19 Summary Annual Reports are provided to all participants annually. SPDs 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 BRENT BOHN - 1421 SOUTH MANHATTAN AVENUE, FULLERTON, CA XXX-XX-XXXX. FRANK AFOA - 750 S. STANFORD AVENUE, LOS ANGELES, CA 90021. RICK MIDDLETON - 450 CARSON PLAZA DRIVE, STE A, CARSON, CA 90746. ERIC TATE - 731 EAST ARROW HIGHWAY, GLENDORA, CA 91740. DUANE SNIDER - 1421 SOUTH MANHATTAN AVENUE, FULLERTON, CA XXX-XX-XXXX. LEROY WESTMORELAND - 301 SOUTH TIPPECANOE AVE, SAN BERNARDINO, CA 92408. ALBERTSON'S 1421 SOUTH MANHATTAN AVE FULLERTON CA 92831 204057706 RETAIL GROCERS CA C 0 STATER BROS 301 S TIPPECANOE SAN BERNARDINO CA 92408 RETAIL GROCERS CA C 0 RALPH'S 1100 W ARTESIA BLVD COMPTON CA 90220 870258768 RETAIL GROCERS CA C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0