2019-07-11T15:52:40-05:00 2018-09-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2017-10-01 946073089 NORTHERN CALIFORNIA BAKERY DRIVERS SECURITY FUND NORT 4155467800 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 JAMES HAM TRUSTEE 4155467800 2019-07-11 1 JESSICA R ROSTER P01317380 9252779100 66.7.226.66 2019-07-11 13:52:31 PD P 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2017 2019-02-21 02:37:17Z JAMES HAM 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 28872687 0 X N/A X 1952 CA TO PROVIDE HEALTH AND WELFARE BENEFITS 6 0 0 0 0 0 0 0 19766553 20197424 -122747 1047972 11978 0 19655784 21245396 0 0 19180586 19536359 4500 4200 0 0 0 1037415 996795 20222501 20537354 -566717 708042 29835919 30373030 3432891 3348680 26403028 27024350 TO PROVIDE HEALTH AND WELFARE BENEFITS TO COVERED EMPLOYEES AND THEIR DEPENDENTS. 0 0 THE FUND PROVIDED WELFARE BENEFITS TO COVERED 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 X 0 0 1 0 0 0 0 0 0 0 X 6 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 4155467800 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 X JOHN BOTTALI TRUSTEE 3.00 X 0 0 0 JAMES HAM TRUSTEE 2.00 X 0 0 0 LOU VALLETTA TRUSTEE 1.00 X 0 0 0 MARTY CRANDALL TRUSTEE 1.00 X 0 0 0 DON HOPKINS TRUSTEE 3.00 X 3300 0 0 JOHN ONTIVEROS TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 0 0 3300 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 1600 HARBOR BAY PKWY STE 200 ALAMEDA CA 94502 FUND ADMINISTRATION 479670 ANTHEM INC 120 MONUMENT CIRCLE INDIANAPOLIS IN 46204 CLAIMS ADMINISTRATION 113970 2 EMPLOYER CONTRIBUTIONS 900099 17048375 17048375 PARTICIPANT CONTRIBUTIONS 900099 2633138 2633138 PRESCRIPTION DRUG REBATES 900099 312362 312362 STOP LOSS INCOME 900099 191442 191442 KAISER OVER PAYMENT 900099 12107 12107 20197424 903162 903162 7772101 7627291 144810 144810 144810 21245396 20197424 0 1047972 19536359 4200 417985 38337 40297 23125 353421 69305 2000 25804 23401 PCORI FEES 3120 20537354 1300556 518818 1522754 1557607 24416 847160 26988193 27449445 29835919 30373030 1835593 1632986 23498 22294 1573800 1693400 3432891 3348680 X 0 0 0 0 26403028 27024350 26403028 27024350 29835919 30373030 708042 -86720 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 1693400 1693400 X 21135551 -86720 -86720 21222271 23125 23125 21245396 20673366 0 20673366 23125 -159137 -136012 20537354 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF SEPTEMBER 30, 2018, 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'S ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO 2015. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART V, LINE 1A THE PLAN'S THIRD PARTY ADMINISTRATOR FILES ONE 1099 ON BEHALF OF ALL THE PLANS THEY ADMINISTER FOR THE VARIOUS "INDEPENDENT CONTRACTORS." THEREFORE, LINE 1A HAS BEEN ANSWERED ZERO. ADDITIONALLY, THE THIRD PARTY ADMINISTRATOR ENSURES THAT THE PLAN IS IN COMPLIANCE WITH THE BACKUP WITHHOLDING RULES. FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH ZENITH AMERICAN SOLUTIONS, INC., TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ARE REQUIRED, ON AN ANNUAL BASIS, TO DISCLOSE ANY RELATIONSHIPS OR INTERESTS THAT COULD GIVE RISE TO A CONFLICT. IF THERE IS A CONFLICT OF INTEREST, THE PERSON INVOLVED IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, LINE 1A ONLY ONE TRUSTEE IS COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES BY OTHER ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX EXEMPT ORGANIZATION. IF YOU WOULD LIKE MORE INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART XII, LINE 2C THE BOARD ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS AND FOR SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. SEE EXPLANATION AT PART VII VARIOUS CA 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 MULITIEMPLOYER TRUST THAT PROVIDES HEALTH BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF SEPTEMBER 30, 2018, THERE ARE APPROXIMATELY 4 EMPLOYERS THAT CONTRIBUTE TO THE TRUST AND 13 SPONSORING ORGANIZATIONS. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS AND SPONSORING ORGANIZATIONS, 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 AND SPONSORING ORGANIZATION IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS AND SPONSORING ORGANIZATIONS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. BIMBO BAKERIES USA ROMA BAKERY, INC. SAFEWAY SVENHARDS SWEDISH BAKERY TEAMSTERS LOCAL 87 TEAMSTERS LOCAL 137 TEAMSTERS LOCAL 150 TEAMSTERS LOCAL 186 TEAMSTERS LOCAL 315 TEAMSTERS LOCAL 386 TEAMSTERS LOCAL 431 TEAMSTERS LOCAL 439 TEAMSTERS LOCAL 853 TEAMSTERS LOCAL 890 TEAMSTERS LOCAL 912 TEAMSTERS LOCAL 948 TEAMSTERS LOCAL 986