2014-05-09T16:31:03-05:00 2013-09-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2012-10-01 946073089 NORTHERN CALIFORNIA BAKERY DRIVERS SECURITY FUND NORT 4155467800 221 MAIN STREET NO 250 SAN FRANCISCO CA 94105 JAMES HAM 4155467800 2014-05-09 1 JESSICA R ROSTER P01317380 9252779100 2012 2015-11-30 17:44:51Z JAMES HAM 221 MAIN STREET NO 250 SAN FRANCISCO CA 94105 26871065 0 X N/A X 1952 CA TO PROVIDE HEALTH AND WELFARE BENEFITS 6 0 0 0 0 0 0 0 30082276 24572963 881514 1040825 37940 3704 31001730 25617492 0 0 30534892 23337367 0 0 0 0 0 1089952 1034264 31624844 24371631 -623114 1245861 28619861 29357958 4225146 3787976 24394715 25569982 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 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 221 MAIN STREET SUITE 250 SAN FRANCISCO CA 94105 JOHN BOTTALI 3.00 X 0 0 0 JAMES HAM 2.00 X 0 0 0 LOU VALLETTA 1.00 X 0 0 0 MARTY CRANDALL 1.00 X 0 0 0 DON HOPKINS 2.00 X 8700 0 0 JOHN ONTIVEROS 1.00 X 0 0 0 8700 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 221 MAIN STREET SUITE 250 SAN FRANCISCO CA 94105 FUND ADMINISTRATION 541827 BLUE CROSS OF CALIFORNIA 21555 OXNARD STREET WOODHILLS CA 91365 ADMINISTRATION 113844 2 EMPLOYER CONTRIBUTIONS 900099 20489188 20489188 PARTICIPANT CONTRIBUTIONS 900099 3593797 3593797 STOP LOSS INCOME 900099 389747 389747 EXPERIENCE RATED REFUNDS 900099 100231 100231 24572963 812398 812398 1482000 1253573 228427 228427 228427 OTHER INCOME 900099 3392 3392 TPL SUBROGATION REFUND 900099 312 312 3704 25617492 24576667 0 1040825 23337367 484760 48599 45231 310973 101580 24456 17314 MISCELLANEOUS EXPENSE 1351 24371631 1295622 2946398 2317078 1913618 1503793 24343 23503368 24473599 28619861 29357958 1703666 1980695 85880 81581 2435600 1725700 4225146 3787976 X 0 0 0 0 24394715 25569982 24394715 25569982 28619861 29357958 1245861 -70594 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 1725700 1725700 X 25546898 -70594 -70594 25617492 0 25617492 24794485 0 24794485 -422854 -422854 24371631 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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, 2013, 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 SEPTEMBER 30, 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH ZENITH AMERICAN SOLUTIONS 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 11 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 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. 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. 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 MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF SEPTEMBER 30, 2013, THERE ARE APPROXIMATELY 5 EMPLOYERS THAT CONTRIBUTE TO THE TRUST AND 11 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 (DISREGARD 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 SARA LEE BAKERY GROUP SVENHARDS SWEDISH BAKERY TEAMSTERS LOCAL 87 TEAMSTERS LOCAL 137 TEAMSTERS LOCAL 150 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 186 TEAMSTERS LOCAL 986