2011-08-01T12:24:34-05:00 2010-09-30 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2009-10-01 946073089 NORTHERN CALIFORNIA BAKERY DRIVERS SECURITY FUND NORT 4155467800 221 MAIN Street 2nd Floor San Francisco CA 94105 James ham 4155467800 2011-08-01 1 9252779100 2009 2016-02-24 21:20:13Z James ham 221 MAIN Street 2nd Floor San Francisco CA 94105 30371386 0 X n/a X 1952 CA to provide health and welfare benefits 6 6 0 0 0 0 0 28283646 27719080 189126 633164 0 28472772 28352244 0 26537135 27454866 0 0 0 1134470 1028536 27671605 28483402 801167 -131158 29268051 30568884 4228468 4345881 25039583 26223003 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 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 0 0 0 1 0 0 1 0 0 0 0 0 0 6 6 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Zenith Administrators Inc 4155467800 221 Main Street Second Floor San Francisco CA 94105 X Jim ham 1.00 X 0 0 0 lou Valletta 1.00 X 0 0 0 marty crandall 1.00 X 0 0 0 Don hopkins 1.00 X 0 0 0 john bottali 1.00 X 0 0 0 JACK GRISSOM 1.00 X 0 0 0 MARK JACOBS 1.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH ADMINISTRATORS 221 MAIN STREET 2ND FLOOR SAN FRANCISCO CA 94105 FUND ADMINISTRATION 530843 ANTHEM BLUE CROSS 21555 OXNARD STREET WOODHILLS CA 91365 ADMINISTRATION 118640 2 Employer Contributions 900099 24159463 24159463 Participant Contributi 900099 2932539 2932539 prescription drug reba 900099 200452 200452 Insurance Refunds 900099 161124 161124 STOP-Loss REIMBURSEMEN 900099 125653 125653 139849 139849 27719080 655306 655306 1997000 2019142 -22142 -22142 -22142 28352244 27719080 0 633164 27454866 473118 42111 44344 323031 86146 27967 18081 miscellaneous expenses 10498 Subscription Expense 2068 MIR compliance expense 1172 28483402 3475392 2910942 2088896 2004315 16547 18506 23687216 25635121 29268051 30568884 1974868 1966181 93000 121000 2160600 2258700 4228468 4345881 X 0 0 0 0 25039583 26223003 25039583 26223003 29268051 30568884 X 0 1 1 X 0 0 Accumulated Eligiblity Credits 2258700 2258700 28352244 28483402 -131158 1314578 76071 1390649 1259491 29666822 1314578 1314578 28352244 0 28352244 28407331 0 28407331 76071 76071 28483402 Part XI, Line 8 - Other Adjustments: CHANGE IN BENEFIT OBLIGATIONS Part XIII, Line 4b - Other Adjustments: Change in benefit obligations Form 990, Part VI, Section A, line 3 THE PLAN HAS CONTRACTED WITH ZENITH ADMINISTRATORS 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 in writing 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 XI, LINE 2C: THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBLITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. 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.