2012-10-11T13:47:06-05:00 2011-12-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2011-01-01 956048844 TEAMSTERS AND FOOD EMPLOYERS SECURITY TRUST FUND TEAM 6262995825 1000 SO FREMONT AVE A9W ALHAMBRA CA 918031121 RICK MIDDLETON 6262995825 2012-10-08 1 RANDY D HENNINGFIELD P01364367 6612953363 2011 2016-02-24 21:20:13Z RICK MIDDLETON 450 CARSON PLAZA DRIVE STE A CARSON CA 90746 147419387 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 135655911 139905791 196879 48160 0 0 135852790 139953951 0 0 129095359 137199758 0 0 0 0 0 8140030 8442050 137235389 145641808 -1382599 -5687857 18113805 12870039 14228740 14716662 3885065 -1846623 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 0 0 145641808 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 145641808 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 0 1 8 0 1 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 MS LUCY KETCHEDJIAN - SOUTHWEST 6262995825 1000 SO FREMONT AVE A9W ALHAMBRA CA 91803 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 3948906 BROADREACH MEDICAL RESOURCES 1350 BROADWAY SUITE 410 NEW YORK NY 10018 CLAIMS PROCESSING 2530580 ANTHEM BLUE CROSS 21555 OXNARD STREET AC PC WOODLAND HILLS CA 91367 NETWORK ACCESS FEES 422714 APS HEALTHCARE BETHESDA INC 32 HAMPDEN STREET SPRINGFIELD MA 01103 CLAIMS PROCESSING 270792 BEECH STREET 25500 COMMERCENTRE DR LAKE FORREST CA 92360 NETWORK ACCESS FEES 255351 7 EMPLOYER CONTRIBUTIONS 445100 135001238 135001238 RETIREE CONTRIBUTIONS 445110 4845334 4845334 COBRA CONTRIBUTIONS 445110 41144 41144 COBRA SUBSIDY 445110 18075 18075 139905791 40822 40822 7472774 7465436 7338 7338 7338 139953951 139905791 0 48160 137199758 137199758 3907003 3907003 237369 237369 20000 20000 30707 30707 168084 168084 27805 27805 ADMINISTRATION - RX 2530580 2530580 PPO NETWORK 1008778 1008778 CONSULTANTS 289311 289311 ADMINISTRATION - VSP 115394 115394 107019 107019 145641808 145641808 0 0 -1361135 -1200283 13630684 12090978 1810052 1952310 12004 27034 3905200 0 117000 0 18113805 12870039 1078731 1061168 13150009 13655494 14228740 14716662 X 0 0 0 0 3885065 -1846623 3885065 -1846623 18113805 12870039 X -5687857 -43831 X 0 1 1 X 0 0 PREMIUMS PAYABLE, IBNR AND ACCUMULATED ELIG. 12593177 DEFERRED RETIREE CONTRIBUTIONS 1062317 13655494 139953951 145641808 -5687857 -43831 -43831 -5731688 139879413 -43831 -43831 139923244 30707 30707 139953951 145583695 0 145583695 30707 27406 58113 145641808 Part XIII, Line 4b - Other Adjustments: CHANGE IN PREMIUMS PAYABLE, IBNR & ACCUM. ELIGIBILITY 27,406. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -43,831. ALBERTSON'S 1421 SOUTH MANHATTAN AVE FULLERTON CA 92831 204057706 RETAIL GROCERS CA C STATER BROS 301 S TIPPECANOE SAN BERNARDINO CA 92408 RETAIL GROCERS CA C VONS SAFEWAY 618 MICHILLINDA AVENUE ARCADIA CA 91007 381623900 RETAIL GROCERS CA C 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