2017-10-06T15:47:41-05:00 2016-12-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2016-01-01 956048844 TEAMSTERS AND FOOD EMPLOYERS SECURITY TRUST FUND TEAM 6266461075 1050 LAKES DRIVE SUITE 120 WEST COVINA CA 91790 RICK MIDDLETON TRUSTEE 6266461075 2017-09-28 1 RANDY D HENNINGFIELD P01364367 6612953363 108.89.97.154 2017-10-06 13:37:18 PD P 468F7E0B5429FFDB8E266DF0556E3F9FFE9372C5 B174AE6F88008EEA395284392A0091C0770EC910 2016 2021-01-29 14:40:06Z RICK MIDDLETON 450 CARSON PLAZA DRIVE CARSON CA 90746 142014325 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 143540177 139607434 211491 280097 3849062 2126794 147600730 142014325 0 0 136506227 129537625 0 0 0 0 0 6151461 6129167 142657688 135666792 4943042 6347533 44544140 50596003 12237561 11861379 32306579 38734624 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 0 0 135666792 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 135666792 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 1495 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 JIM PRATER 6266461090 1050 LAKES DRIVE SUITE 225 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 KATHLEEN FINAZZO 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 ERIC TATE 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 2871105 BROADREACH MEDICAL RESOURCES 1350 BROADWAY SUITE 410 NEW YORK NY 10018 CLAIMS PROCESSING 1769389 ANTHEM BLUE CROSS 21555 OXNARD STREET AC PC WOODLAND HILLS CA 91367 NETWORK ACCESS FEES 322541 HEALTH MANAGEMENT CONCEPTS 32 HAMPDEN STREET SPRINGFIELD MA 01103 CLAIMS PROCESSING 108658 4 EMPLOYER CONTRIBUTIONS 445100 132217234 132217234 RETIREE CONTRIBUTIONS 445100 7106186 7106186 COBRA CONTRIBUTIONS 445100 284014 284014 139607434 280097 280097 RETIREE PRESCRIPTION SUBSIDY 445100 991476 991476 PRESCRIPTION REBATES 445100 980601 980601 STOP LOSS RECOVERIES 445100 154717 154717 2126794 142014325 141734228 0 280097 129537625 129537625 2871105 2871105 189493 189493 22000 22000 248143 248143 3956 3956 50519 50519 ADMINISTRATION - RX 1769389 1769389 PPO NETWORK 451199 451199 CONSULTANTS 257905 257905 ADMINISTRATION - VSP 85933 85933 179525 179525 135666792 135666792 0 0 15075876 14901472 4365991 5198177 1505 34976 25100768 30461378 44544140 50596003 367676 566221 11869885 11295158 12237561 11861379 X 0 0 0 0 32306579 38734624 32306579 38734624 44544140 50596003 6347533 80512 0 X 0 1 X 1 0 0 PREMIUMS PAYABLE, IBNR AND ACCUMULATED ELIG. 10594758 DEFERRED RETIREE CONTRIBUTIONS 700400 11295158 142094837 80512 80512 142014325 0 142014325 136220745 0 136220745 -553953 -553953 135666792 Part XII, Line 4b - Other Adjustments: CHANGE IN PREMIUMS PAYABLE, IBNR & ACCUM. ELIGIBILITY -553,953. 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. KATHLEEN FINAZZO - 301 S. TIPPECANOE, SAN BERNARDINO, CA 92408. DOUGLAS RUYGROK - 618 MICHILLINDA AVENUE, ARCADIA, CA 91007. LEROY WESTMORELAND - 1100 W ARTESIA BLVD., COMPTON, CA 90220. ERIC TATE - 731 EAST ARROW HIGHWAY, GLENDORA, CA 91740. 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