2023-03-10T10:19:41-06:00 2022-04-30 WITHUMSMITHBROWNPC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2021-05-01 946284253 JOINT BENEFIT TRUST % HEALTH SERVICES & BENEFITS A JOIN 9258837300 4160 DUBLIN BOULEVARD Suite 400 DUBLIN CA 94568 STACEY CUE Co-Chair 9258837300 2023-03-15 true STACEY CUE 999009999 JOSEPH M THIERMANN P01066616 9252779100 2023-03-15 2021 2023-04-26 12:10:37Z STACEY CUE 4160 DUBLIN BOULEVARD400 DUBLIN CA 94568 143594251 false X N/A X 1972 CA PROVIDE HEALTH AND WELFARE BENEFITS 8 0 0 0 0 0 0 53850956 60917479 701087 1083215 23168 18 54575211 62000712 0 0 49130072 44076359 0 0 0 0 0 4941014 4978964 54071086 49055323 504125 12945389 49851137 57691300 13595741 10230529 36255396 47460771 TO PROVIDE HEALTH AND WELFARE BENEFITS. false false HEALTH AND WELFARE BENEFITS PROVIDED UNDER COLLECTIVE BARGAINING FOR PARTICIPANTS. false false false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 302 0 true 0 false false false false false false false false false X 8 0 false true false false false false false true false false false true true true true true true false false false X HEALTH SERVICES BENEFITS A 9258337300 4160 DUBLIN BLVD STE 400 DUBLIN CA 94588 X ASHLEY ALVARADO CHAIR 3.0 0.0 X X 0 0 0 STACEY CUE CO-CHAIR 3.0 0.0 X X 0 0 0 LUIS DIAZ TRUSTEE 2.5 0.0 X 0 0 0 PETER FINN TRUSTEE 2.5 0.0 X 0 0 0 JP BRADLEY TRUSTEE 2.5 0.0 X 0 0 0 JOTI AULAK TRUSTEE 2.5 0.0 X 0 0 0 ADAM SROUFE TRUSTEE 2.5 0.0 X 0 0 0 CRESCENCIO DIAZ TRUSTEE 2.5 0.0 X 0 0 0 ADAM OCHOA TRUSTEE - PAST 2.5 0.0 X 0 0 0 ERIC INGRAM TRUSTEE - PAST 2.5 0.0 X 0 0 0 MICHAEL MENDOZA TRUSTEE - PAST 2.5 0.0 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.0 0.0 X 0 0 0 0 0 0 0 false false false HEALTH SERVICES BENEFIT ADMIN 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 ADMINISTRATOR FEES 3127534 BLUE CROSS OF CALIFORNIA DEPARTMENT 5812 LOS ANGELES CA 90074 PPO NETWORK FEE 655240 HEALTH SERVICES FOUNDATION 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 BENEFIT ADMIN. 290750 THE SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARIAL & CONSULT. 233689 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 ACCOUNTING FEES 152628 7 0 EMPLOYER CONTRIBUTIONS 525100 50092381 50092381 STOP-LOSS RECOVERY 525100 2485486 2485486 PRESCRIPTION REBATE INCOME 525100 1820085 1820085 EMPLOYEE CONTRIBUTIONS 525100 767112 767112 MEDICAL SETTLEMENT 525100 5752415 5752415 60917479 673254 673254 0 0 0 0 0 82003500 81593539 409961 409961 409961 0 0 0 0 0 0 0 0 0 OTHER INCOME 900099 18 18 18 62000712 60917497 1083215 0 0 0 44076359 0 0 0 0 0 0 3012840 161892 128512 0 0 104107 1278622 0 214717 0 0 0 0 0 4754 0 0 0 48108 PCORI TAX 24102 OTHER EXPENSES 1310 49055323 665153 647280 0 0 0 0 6259613 10875294 0 0 0 0 0 0 0 0 68496 89910 0 0 42857875 46078816 0 0 0 0 0 0 0 0 49851137 57691300 442039 138426 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13153702 10092103 13595741 10230529 X 0 0 0 0 36255396 47460771 36255396 47460771 49851137 57691300 12945389 -1740014 X false true X true false 0 ACCUMULATED ELIGIBILITY CREDITS 3420103 GROUP INSURANCE PREMIUMS PAYABLE 322000 CLAIMS PAYABLE & INCURRED BUT NOT REPORTED 6350000 10092103 X 60156591 -1740014 -1740014 61896605 104107 104107 62000712 52012815 52012815 104107 -3061599 -2957492 49055323 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, 2022, 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 2019. PART XII, LINE 4B: 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 11B: 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 ORGANIZATION 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 1933 W CALDWELL AVENUE VISALIA CA 93277 942801732 LABOR ORG. CA 501(C)(5) N/A NA false TEAMSTERS LOCAL UNION 856 453 SAN MATEO AVENUE SAN BRUNO CA 94066 941211646 LABOR ORG. CA 501(C)(5) N/A NA false TEAMSTERS LOCAL UNION 948 2354 W WHITENDALE AVENUE VISALIA CA 93277 941310598 CONTRIB. EMP. 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