2018-08-24T15:20:59-05:00 2017-12-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2017-01-01 956048844 TEAMSTERS AND FOOD EMPLOYERS SECURITY TRUST FUND TEAM 6266461075 1050 LAKES DRIVE SUITE 120 WEST COVINA CA 91790 RICK MIDDLETON TRUSTEE 6266461075 2018-08-24 1 RANDY D HENNINGFIELD P01364367 6612953363 2017 2022-09-23 18:48:47Z RICK MIDDLETON 450 CARSON PLAZA DRIVE CARSON CA 90746 141637757 0 X N/A X 1950 CA HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 7 7 0 0 0 0 0 0 139607434 137017065 280097 351498 2126794 4269194 142014325 141637757 0 0 129537625 135381531 0 0 0 0 0 6129167 6479052 135666792 141860583 6347533 -222826 50596003 49162840 11861379 10712702 38734624 38450138 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 0 0 141860583 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 141860583 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 1534 0 1 0 0 0 0 0 0 0 0 0 X 7 7 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 PATRICK KELLY 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 DOUGLAS RUYGROK TRUSTEE 10.00 X 0 0 0 LEROY WESTMORELAND TRUSTEE 10.00 X 0 0 0 DUANE SNIDER 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 2866191 BROADREACH MEDICAL RESOURCES 1350 BROADWAY SUITE 410 NEW YORK NY 10018 CLAIMS PROCESSING 1693987 PART D ADVISORS INC 17199 N LAUREL PARK DRIVE STE 400 LIVONIA MI 48152 PRESCRIPTION AUDIT 444495 ANTHEM BLUE CROSS 32 HAMPDEN STREET SPRINGFIELD MA 01103 NETWORK ACCESS FEES 344842 SEYFARTH SHAW ONE CENTURY PARK EAST STE 3500 LOS ANGELES CA 90067 LEGAL 106929 6 EMPLOYER CONTRIBUTIONS 445100 129609177 129609177 RETIREE CONTRIBUTIONS 445100 7083582 7083582 COBRA CONTRIBUTIONS 445100 324306 324306 137017065 351498 351498 RETIREE PRESCRIPTION SUBSIDY 445100 2429733 2429733 PRESCRIPTION REBATES 445100 1804177 1804177 STOP LOSS RECOVERIES 445100 35284 35284 4269194 141637757 141286259 0 351498 135381531 135381531 2866191 2866191 168842 168842 22000 22000 238669 238669 7544 7544 58373 58373 ADMINISTRATION - RX 1693987 1693987 PPO NETWORK 510020 510020 PRESCRIPTION AUDIT 444495 444495 CONSULTANTS 273732 273732 195199 195199 141860583 141860583 0 0 14901472 13395131 5198177 4978670 34976 37824 30461378 30751215 50596003 49162840 566221 433992 11295158 10278710 11861379 10712702 X 0 0 0 0 38734624 38450138 38734624 38450138 50596003 49162840 -222826 -61660 0 X 0 1 X 1 0 0 PREMIUMS PAYABLE, IBNR AND ACCUMULATED ELIG. 9577435 DEFERRED RETIREE CONTRIBUTIONS 701275 10278710 141576097 -61660 -61660 141637757 0 141637757 142877906 0 142877906 -1017323 -1017323 141860583 Part XII, Line 4b - Other Adjustments: CHANGE IN PREMIUMS PAYABLE, IBNR & ACCUM. ELIGIBILITY -1,017,323. 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. PATRICK KELLY - 140 SOUTH MARKS WAY, ORANGE, CA 92868. RICK MIDDLETON - 450 CARSON PLAZA DRIVE, STE A, CARSON, CA 90746. ERIC TATE - 731 EAST ARROW HIGHWAY, GLENDORA, CA 91740. DOUGLAS RUYGROK - 1421 SOUTH MANHATTAN AVENUE, FULLERTON, CA XXX-XX-XXXX. LEROY WESTMORELAND - 1100 W ARTESIA BLVD., COMPTON, CA 90220. DUANE SNIDER - 301 SOUTH TIPPECANOE AVE, SAN BERNARDINO, CA 92408. ALBERTSON'S LLC 1421 SOUTH MANHATTAN AVE FULLERTON CA 92831 RETAIL GROCERS CA C 0 STATER BROS 301 S TIPPECANOE SAN BERNARDINO CA 92408 RETAIL GROCERS CA C 0 VONS SAFEWAY 618 MICHILLINDA AVENUE ARCADIA CA 91007 381623900 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