2013-10-10T19:09:44-05:00 2012-12-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2012-01-01 956048844 TEAMSTERS AND FOOD EMPLOYERS SECURITY TRUST FUND TEAM 6266461075 1050 LAKES DRIVE SUITE 225 WEST COVINA CA 91790 RICK MIDDLETON 6266461075 2013-10-10 1 RANDY D HENNINGFIELD P01364367 6612953363 2012 2016-02-25 16:41:14Z RICK MIDDLETON 450 CARSON PLAZA DRIVE STE A CARSON CA 90746 143458226 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 139905791 142655066 48160 3483 0 0 139953951 142658549 0 0 137199758 127069441 0 0 0 0 0 8442050 7216246 145641808 134285687 -5687857 8372862 12870039 22133322 14716662 15607205 -1846623 6526117 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 0 0 134285687 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 134285687 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 0 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 10.00 X 0 0 0 PATRICK KELLY 10.00 X 0 0 0 RICK MIDDLETON 10.00 X 0 0 0 KATHLEEN FINAZZO 10.00 X 0 0 0 DOUGLAS RUYGROK 10.00 X 0 0 0 LEROY WESTMORELAND 10.00 X 0 0 0 CREG QUIROZ 10.00 X 0 0 0 0 0 0 0 0 0 0 SOUTHWEST ADMINISTRATORS INC 1000 SOUTH FREMONT AVE A9W ALHAMBRA CA 91803 CONTRACT ADMINISTRATION 2910963 BROADREACH MEDICAL RESOURCES 1350 BROADWAY SUITE 410 NEW YORK NY 10018 CLAIMS PROCESSING 2343297 ANTHEM BLUE CROSS 21555 OXNARD STREET AC PC WOODLAND HILLS CA 91367 NETWORK ACCESS FEES 393083 BENESYS ADMINISTRATORS 1050 LAKES DR SUITE 120 WEST COVINA CA 91790 CONTRACT ADMINISTRATION 268000 APS HEALTHCARE BETHESDA INC 32 HAMPDEN STREET SPRINGFIELD MA 01103 CLAIMS PROCESSING 245378 8 EMPLOYER CONTRIBUTIONS 445100 135857437 135857437 RETIREE CONTRIBUTIONS 445110 6766916 6766916 COBRA CONTRIBUTIONS 445110 30713 30713 142655066 3360 3360 799800 799677 123 123 123 142658549 142655066 0 3483 127069441 127069441 3136833 3136833 300544 300544 32000 32000 -30707 -30707 109418 109418 39945 39945 ADMINISTRATION - RX 2343297 2343297 PPO NETWORK 809979 809979 CONSULTANTS 266916 266916 ADMINISTRATION - VSP 94620 94620 113401 113401 134285687 134285687 0 0 -1200283 18751913 12090978 945975 1952310 2399056 27034 36378 12870039 22133322 1061168 672202 13655494 14935003 14716662 15607205 X 0 0 0 0 -1846623 6526117 -1846623 6526117 12870039 22133322 8372862 -122 0 X 0 1 X 1 0 0 PREMIUMS PAYABLE, IBNR AND ACCUMULATED ELIG. 13956359 DEFERRED RETIREE CONTRIBUTIONS 978644 14935003 142689134 -122 -122 142689256 -30707 -30707 142658549 132953212 0 132953212 -30707 1363182 1332475 134285687 Part XII, Line 4b - Other Adjustments: CHANGE IN PREMIUMS PAYABLE, IBNR & ACCUM. ELIGIBILITY 1,363,182. 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 11 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. Contact Addresses for Officers, Directors, Etc Form 990, Part VII 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. CREG QUIROZ - 379 WEST VALLEY BLVD., RIALTO, CA 92376. ALBERTSON'S 1421 SOUTH MANHATTAN AVE FULLERTON CA 92831 204057706 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