2017-02-09T16:18:52-06:00 2016-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2015-05-01 946284253 JOINT BENEFIT TRUST JOIN 9258837300 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 94568 MARIA ASHLEY ALVARADO TRUSTEE 9258837300 2017-02-09 1 JOSEPH M THIERMANN P01066616 9252779100 2015 2021-01-29 14:40:06Z MARIA ASHLEY ALVARADO 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 94568 97748767 0 X N/A X 1972 CA PROVIDE HEALTH AND WELFARE BENEFITS 8 0 0 0 0 0 0 0 48559069 51251487 168229 209166 20958 31 48748256 51460684 0 0 39251593 41736423 0 0 0 0 0 5612515 5867843 44864108 47604266 3884148 3856418 31408721 35041113 9007029 8709600 22401692 26331513 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 HEALTH AND WELFARE BENEFITS PROVIDED UNDER COLLECTIVE BARGAINING FOR PARTICIPANTS. 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 1 319 0 1 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICES & BENEFIT ADMINISTRATORS 9258337300 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 X ASHLEY ALVARADO TRUSTEE 3.00 X 0 0 0 CRESCENCIO DIAZ TRUSTEE 2.50 X 0 0 0 RICHARD EHRLER TRUSTEE-PAST 3.00 X 0 0 0 ADAM OCHOA TRUSTEE 2.50 X 0 0 0 JUSTIN MULLINS TRUSTEE 2.50 X 0 0 0 PABLO BARRERA TRUSTEE 2.50 X 0 0 0 TOM NETT TRUSTEE 2.50 X 0 0 0 THUY WAGNER TRUSTEE-PAST 2.50 X 0 0 0 STACEY CUE TRUSTEE 3.00 X 0 0 0 ADAM SROUFE TRUSTEE 2.50 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.00 X 0 1 0 0 1 0 0 0 0 0 HEALTH SERVICES & BENEFIT ADMIN 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 ADMINISTRATOR FEES 3330456 BLUE CROSS OF CALIFORNIA DEPARTMENT 5812 LOS ANGELES CA 900745812 PPO NETWORK FEE 592621 THE SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARIAL AND CONSULTING FEES 319739 AMERICAN HEALTH WAYS PO BOX 166718 ATLANTA GA 303687180 ADMINISTRATION FEES 287207 BEESON TAYER & BODINE 483 9TH ST STE 200 OAKLAND CA 94607 LEGAL EXPENSE 220447 7 EMPLOYER CONTRIBUTIONS 900099 48355990 48355990 EMPLOYEE CONTRIBUTIONS 900099 1841640 1841640 PRESCRIPTION REBATE INCOME 900099 570322 570322 STOP-LOSS RECOVERY 900099 307834 307834 CAREMARK REBATE INCOME 900099 175701 175701 51251487 344767 344767 46152482 46288083 -135601 -135601 -135601 OTHER INCOME 900099 31 31 31 51460684 51251518 0 209166 41736423 3070447 297377 125454 41940 1652773 275120 79462 41347 TRANSITIONAL REINSURANC 260524 PCORI TAX 22284 OTHER EXPENSES 1115 47604266 188742 788490 3834522 4539606 38237 31650 27156928 29491075 190292 190292 31408721 35041113 514306 649278 8492723 8060322 9007029 8709600 X 0 0 0 0 22401692 26331513 22401692 26331513 31408721 35041113 3856418 73403 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 3254322 GROUP INS PREMIUMS PAYABLE 489000 CLAIMS PAYABLE AND IBNR 4317000 8060322 X 51492147 73403 73403 51418744 41940 41940 51460684 47994727 0 47994727 41940 -432401 -390461 47604266 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF APRIL 30, 2016, 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 FISCAL YEARS PRIOR TO 2013. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT-OF-INTEREST POLICY COVERS TRUSTEES, OFFICERS AND ALL MANAGEMENT EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF THE FUND. THE POLICY PROVIDES SEVERAL EXAMPLES OF TRANSACTIONS THAT WOULD BE CONSIDERED A CONFLICT OF INTEREST. IT IS ASSUMED THAT THE TRUSTEES, OFFICERS AND MANAGEMENT WILL RECOGNIZE CONFLICTS BASED ON THE EXAMPLES, OR BY ANALOGY WITH THE EXAMPLES, PROVIDED IN THE POLICY. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE FUND MANAGER OR CHAIRMAN. TRANSACTIONS MAY BE UNDERTAKEN ONLY IF THEY ARE FULLY DISCLOSED, THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION, A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS, AND THE FUND MANAGER OR CHAIRMAN HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTERESTS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, THE CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 11A: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED NON-PROFIT ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC. FORM 990, PART XII, LINE 2C: THE BOARD ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDITED FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. TEAMSTERS CA STATE COUNCIL OF CANNERY & FOOD PROCESSING UNIONS 1933 W CALDWELL AVENUE VISALIA CA 93277 942801732 LABOR ORGANIZATION CA 501(C)(5) N/A N/A 0 CALIFORNIA PROCESSORS INC 2200 POWELL STREET SUITE 1000 EMERYVILLE CA 94608 940360771 TO PROVIDE LABOR RELATIONS SERVICES TO MEMBERS OF CPI CA 501(C)(6) N/A N/A 0 CANNERY WAREHOUSEMEN FOOD PROCESSORS DRIVERS AND HELPERS UNION NO 601 CONTRIBUTING EMPLOYER 0 TEAMSTERS LOCAL UNION 948 TEAMSTERS CANNERY WORKERS FOOD PROCESSORS & HELP CONTRIBUTING EMPLOYER 0 MOTT'S LLP CONTRIBUTING EMPLOYER 0 0 DEL MONTE CORPORATION CONTRIBUTING EMPLOYER 0 CAMPBELL SOUP SUPPLY CO CONTRIBUTING EMPLOYER 0 H J HEINZ COMPANY CONTRIBUTING EMPLOYER 0 HORMEL FOODS CORP CONTRIBUTING EMPLOYER 0 CON AGRA CONTRIBUTING EMPLOYER 0 PACIFIC COAST PRODUCERS CONTRIBUTING EMPLOYER 0 UNILEVER SUPPLY CHAIN INC CONTRIBUTING EMPLOYER 0 STANISLAUS FOOD PRODUCTS CONTRIBUTING EMPLOYER 0 SENECA FOODS LLC CONTRIBUTING EMPLOYER 0 CASCADE LOGISTICS CONTRIBUTING EMPLOYER 0 DOLE PROCESSED FOODS CONTRIBUTING EMPLOYER 0 GENERAL MILLS CONTRIBUTING EMPLOYER 0 MOMENTIVE SPECIALTY CHEMICALS INC CONTRIBUTING EMPLOYER 0 NESTLE CORPORATION CONTRIBUTING EMPLOYER 0 REXAM CONTRIBUTING EMPLOYER 0 SILGAN CONTAINER COMPANY CONTRIBUTING EMPLOYER 0 SUN GARDEN CONTRIBUTING EMPLOYER 0 HEXION INC CONTRIBUTING EMPLOYER 0 OLAM SPICES AND VEGETABLES CONTRIBUTING EMPLOYER 0 R&B FOODS CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0