2018-05-14T14:45:10-05:00 2017-06-30 952648289 VAVRINEK TRINE DAY & CO LLP 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2016-07-01 946434612 WHOLESALE BEER DISTRIBUTORS INDUSTRY TRUST FUND WHOL 6505729611 5776 STONERIDGE MALL ROAD NO 290 PLEASANTON CA 94588 TRUSTEE TRUSTEE TRUSTEE 6505729611 2018-05-14 1 P01781096 9094664410 2016 2022-09-23 18:48:47Z 5776 STONERIDGE MALL ROAD NO 290 PLEASANTON CA 94588 14049125 0 X N/A X 1981 CA SEE (A) BELOW 4 4 0 0 0 0 0 0 16309996 14008735 29519 18752 23713 21638 16363228 14049125 0 0 15008011 13673608 0 0 0 0 0 962205 472119 15970216 14145727 393012 -96602 6281584 5195378 1681575 650471 4600009 4544907 NONE 0 0 TO PROVIDE HEALTH CARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENT BETWEEN THE UNION AND EMPLOYERS AND NON-UNION EMPLOYER AGREEMENTS WITH THE TRUST 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 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 X PREFERRED BENEFIT INSURANCE ADMIN 6505729611 5776 STONERIDGE MALL ROAD SUITE 290 PLEASANTON CA 94588 X CES BUTNER TRUSTEE 5.00 X 0 0 0 PATRICK LAWING TRUSTEE 5.00 X 0 0 0 CATHERINE FOX TRUSTEE 5.00 X 0 0 0 DAVE BOTTOMLEY TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM BLUE CROSS PO BOX 60007 LOS ANGELES CA 90060 CLAIMS ADMINISTRATION 153569 PREFERRED BENEFIT INSURANCE ADMINISTRATO 5776 STONERIDGE MALL RD PLEASANTON CA 94588 CONTRACT ADMINISTRATOR 117958 2 EMPLOYER CONTRIBUTIONS 900099 14008735 14008735 14008735 18752 18752 INSURANCE REFUNDS 900099 21638 21638 21638 14049125 14030373 0 18752 13673608 369612 13200 39013 6777 30800 1302 12905 PCORI FEE 3897 MISCELLANEOUS FEE 534 TRANSITIONAL REINSURANC -5921 14145727 2808090 4578719 14363 0 1467222 616659 1646059 0 345850 0 6281584 5195378 93515 114796 1588060 535675 1681575 650471 X 0 0 0 0 4600009 4544907 4600009 4544907 6281584 5195378 -96602 41500 0 X X 0 1 X 0 0 0 GROUP INSURANCE PREMIUMS PAYABLE 535675 535675 X 14090625 41500 41500 14049125 0 14049125 14145727 0 14145727 0 14145727 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE PLAN MANAGEMENT BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. THE PLAN MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR FISCAL YEARS PRIOR TO JUNE 30, 2014. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEE'S WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES DESIGNATE THE ADMINISTRATOR TO REVIEW THE FORM. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE PLAN'S FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR. VARIOUS - SEE SUPPLEMENTAL SCHEDULE VARIOUS - SEE SUPPLEMENTAL SCHEDULE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART IV, LINE 24 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ENTITY IS A 501(C)(9) VEBA WHO MUST LIST CONTRIBUTING EMPLOYERS ON SCHEDULE R. THE ADMINISTRATIVE OFFICE MAINTAINS A LIST OF CONTRIBUTING EMPLOYERS, HOWEVER, THAT LIST DOES NOT INCLUDE FEDERAL TAX CLASSIFICATION. THEREFORE, THE LIST OF CONTRIBUTING EMPLOYERS IS REPORTED ON PART VII, SUPPLEMENTAL INFORMATION. BOTTOMLEY DISTRIBUTING ANHEUSER BUSCH-HORIZON BEVERAGE MATAGRANO, INC. HORIZON BEVERAGE M. E. FOX AND COMPANY, INC. HUNTERS POINT BREWING ALLIED BEVERAGES, INC. REDDING DISTRIBUTING COMPANY FOOTHILL DISTRIBUTING HL & S TRUCKING CO., INC. SUPERIOR PRODUCTS COMPANY CENTRAL COAST DISTRIBUTING, LLC MORRIS DISTRIBUTING BENITES DISTRIBUTING CO. ALFORD DISTRIBUTING CLAYPOOL DISTRIBUTING COMPANY EASTERN SIERRA WHOLESALERS, INC. GILLESPIE DIST. CO., INC. D & L DISTRIBUTING SUPERIOR PRODUCTS MOUNTAIN (LASSEN) HIGH SIERRA DISTRIBUTING ADVANCE BEVERAGE MT. SHASTA BOTTLING & DIST. INC. WONDERLAND DISTRIBUTING CO., INC. BLACK DIAMOND BREWING COMPANY ALDRIDGE & COMPANY HANNEY ASSOCIATES BEVHAUL LOGISTICS PACIFIC HEALTH ALLIANCE