2020-09-14T16:58:49-05:00 2019-11-30 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2018-12-01 866052021 TEAMSTERS WESTERN REGION AND NEW JERSEY HEALTH CARE FUND TEAM 6022493582 2550 W UNION HILLS DRIVE SUITE 290 PHOENIX AZ 85027 DOUGLAS RUYGROK TRUSTEE 6022493582 2020-09-11 1 RANDY D HENNINGFIELD P01364367 6612953363 198.72.137.241 2020-09-14 14:47:49 PD P ED07B1E9E66BA0EF5981C867B3B832C67439175D ED07B1E9E66BA0EF5981C867B3B832C67439175D 2018 2021-09-10 13:11:23Z DOUGLAS RUYGROK 1421 MANHATTAN AVE FULLERTON CA 92831 1264862329 0 X N/A X 1950 AZ HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 8 8 0 0 0 0 0 0 693124596 810906707 48751553 68990793 23925503 24382208 765801652 904279708 0 0 535503507 585643477 0 0 0 0 0 32553014 33476202 568056521 619119679 197745131 285160029 1334707620 1706259010 58745902 70005000 1275961718 1636254010 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 585643477 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 585643477 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 2006 0 1 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X SOUTHWEST SERVICE ADMINISTRATORS 6022493582 2550 W UNION HILLS DRIVE STE 290 PHOENIX AZ 85027 KARLA SCHUMANN TRUSTEE 4.00 X 0 0 0 DOUGLAS RUYGROK TRUSTEE 15.00 X 30000 0 0 ANDREW MARSHALL TRUSTEE 4.00 X 0 0 0 BJ DORFMAN TRUSTEE 4.00 X 0 0 0 CHRIS LANGAN TRUSTEE 4.00 X 0 0 0 ALFRED BETTS TRUSTEE 4.00 X 0 0 0 MARK DAVISON TRUSTEE 4.00 X 0 0 0 DANNY MA TRUSTEE 4.00 X 0 0 0 30000 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD AZ 8220 N 23RD AVENUE PHOENIX AZ 85021 PPO NETWORK / CLAIMS PROCESSING 12193603 AETNA PO BOX 14079 LEXINGTON KY 40512 PPO NETWORK / CLAIMS PROCESSING 6632706 SOUTHWEST SERVICE ADMINISTRATORS 2500 W UNION HILLS DRIVE STE 29 PHOENIX AZ 85027 CONTRACT ADMINISTRATOR 3831917 EXPRESS SCRIPTS 1 EXPRESS WAY ST LOUIS MO 63121 CLAIMS PROCESSING 1183397 BEACON HEALTH OPTIONS 200 STATE STREET BOSTON MA 02109 CLAIMS PROCESSING 1114259 23 EMPLOYER CONTRIB 480000 804470289 804470289 PARTICIPANT CONTRIB 480000 6436418 6436418 810906707 30748306 30748306 398825108 360582621 38242487 38242487 38242487 PRESCRIPTION REBATES 480000 24282790 24282790 RETIREE PRESCRIPTION SUBSIDY 480000 99418 99418 24382208 904279708 835288915 0 68990793 585643477 585643477 3752083 3752083 332546 332546 137212 137212 5168021 5168021 547344 547344 833369 833369 109020 109020 173493 173493 COST CONTAINMENT FEES 20300573 20300573 ADMINISTRATION - EXTERN 1621095 1621095 DISABILITY PAYROLL TAXE 309923 309923 PCORI FEES 155208 155208 36315 36315 619119679 585643477 33476202 0 6099785 -342370 81058867 100982835 114675 117111 1247434293 1605501434 1334707620 1706259010 7464867 8254899 404647 489745 50876388 61260356 58745902 70005000 X 0 0 0 0 1275961718 1636254010 1275961718 1636254010 1334707620 1706259010 285160029 75132263 0 X 0 1 X 1 0 0 CLAIMS PAYABLE AND IBNR 61345000 PREMIUMS PAYABLE -84644 61260356 975059941 75132263 75132263 899927678 4352030 4352030 904279708 604383681 0 604383681 4352030 10383968 14735998 619119679 Part XII, Line 4b - Other Adjustments: CHANGES IN CLAIMS PAYABLE AND IBNR CHANGE IN PREMIUMS PAYABLE 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 11b A COPY OF FORM 990 WAS PRESENTED TO THE TRUSTEES FOR REVIEW AND SIGNATURES. Form 990, Part VI, Section B, line 12c MONITORING AND ENFORCEMENT OF CONFLICT OF INTEREST POLICY IS APPROVED ANNUALLY AT BOARD OF TRUSTEES MEETING. Form 990, Part VI, Section C, line 19 SUMMARY ANNUAL REPORTS ARE PROVIDED TO ALL PARTICIPANTS ANNUALLY. SPDS ARE AVAILABLE VIA WEBSITE AND FROM THE ADMINISTRATOR UPON REQUEST. AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY REQUEST OF THE DOL OR ADMINISTRATION. Form 990, Part VII Contact Addresses for Officers, Directors, Etc KARLA SCHUMANN - 1450 S 27TH STREET, PHOENIX, AZ 85009. DOUGLAS RUYGROK - 1421 MANHATTAN AVE, FULLERTON, CA 92831. ANDREW MARSHALL - 450 CARSON PLAZA DRIVE, CARSON, CA 90746. B.J. DORFMAN - 55 GLENLAKE PKWY, ATLANTA, GA 30328. CHRIS LANGAN - 2618 CORRAL DR, CELINA, TX 75009. ALFRED BETTS - 282 HILLSIDE AVE, HILLSIDE, NJ 07205. MARK DAVISON - 1850 NE 162ND AVENUE, PORTLAND, OR 97230. DANNY MA - 20227 N 27TH AVENUE, PHOENIX, AZ 85027. ALLIANCE BEVERAGE DISTRIBUTING CO LLC 1115 N 47TH AVE PHOENIX AZ 85043 860933201 SALES AND DISTRIBUTION OF ALCOHOLIC BEVERAGES AZ C 0 ARIZONA STATE AFL-CIO 3117 N 16TH STREET STE 200 PHOENIX AZ 85016 866053031 LABOR MOVEMENT AZ C 0 ATLAS LOGISTICS GROUP RETAIL SERVICES 500 W 99TH AVENUE TOLLESON AZ 85353 271976487 WAREHOUSING AZ C 0 BAKER COMMODITIES INC 3602 W ELWOOD STREET PHOENIX AZ 85009 952137748 RECYCLING AZ C 0 CALIPORTLAND COMPANY 2400 N CENTRAL AVE STE 301 PHOENIX AZ 85004 950597220 CONTRETE, SAND AND GRAVEL PRODUCTION AZ C 0 CALMAT CO VULCAN MATERIALS 500 N BRAND BLVD STE 500 GLENDALE CA 91203 950645790 CONSTRUCTION MATERIALS AL C 0 CENTURY MATERIALS INC 100 S PRICE ROAD TEMPE AZ 85281 860431562 TRANSPORTATION & EQUIPMENT MAINTENANCE FOR CONSTRUCTION AZ C 0 THE HERTZ CORPORATION 225 BRAE BLVD PARK RIDGE NJ 07656 131938568 RENTAL OF PASSENGER VEHICLES NJ C 0 INTERSTATE BRANDS 12 E ARMOUR BLVD KANSAS CITY MO 64111 440296705 FOOD MANUFACTURER TX C 0 KELLOGG COMPANY ONE KELLOGG SQUARE BATTLE CREEK MI 49017 380710690 MANUFACTURING MI C 0 MARTENS HEAVY EQUIPMENT REPAIR LLC 4385 N BAKER DRIVE KINGMAN AZ 86409 274369965 REPAIR, SERVICE AND TRANSPORT - TRUCKS AND HEAVY EQUIPMENT AZ S 0 MISSION LINEN SUPPLY 702 E MONTECITO ST SANTA BARABARA CA 93103 951942549 TEXTILE RENTAL SERVICE CA S 0 CLINTON CAMPBELL CONTR INC PHOENIX BRICK YARD 1814 S 7TH AVE PHOENIX AZ 85007 860010120 CLAY BRICK DISTRIBUTOR AZ C 0 RELIANCE STEEL & ALUMINUM CO 350 S GRAND AVE STE 5100 LOS ANGELES CA 90071 951142616 METAL DISTRIBUTOR CA C 0 RUAN TRANSPORT CORPORATION 666 GRAND AVE DES MOINES IA 50309 420619339 TRANSPORTATION - HAULING OF GOODS IA C 0 SAFEWAY INC 5918 STONERIDGE MALL ROAD PLEASANTON CA 94588 943019135 RETAIL CA C 0 EARTHGRAINS BAKING COMPANIES INC SARA LEE BAKERY 225 STEWART ROAD HANOVER TWP PA 18706 710051040 MANUFACTURING PA C 0 SMITH PIPE AND STEEL COMPANY 735 N 19TH AVE PHOENIX AZ 85009 860351813 STEEL SERVICE CENTER AZ C 0 STAKER AND PARSON CO 2350 SO 1900 WEST OGDEN UT 84401 870674587 CONSTRUCTION, CONCRETE, PAVING UT C 0 PROFESSIONAL TRANSIT MANAGEMENT OF TICSON INC SUN TRAN 3920 N SUN TRAN BLVD TUCSON AZ 85705 311654328 CITY BUSY SYSTEM AZ C 0 SYSCO ARIZONA INC 611 SO 80TH AVE TOLLESON AZ 85353 760254397 WHOLESALE FOOD DISTRIBUTOR AZ C 0 T PAC A DIVISION OF KIEWIT WESTERN 12720 I STREET OMAHA NE 68137 470640264 CONSTRUCTION NE C 0 UNITED DAIRYMEN OF ARIZONA 2008 S HARDTY DR TEMPE AZ 85282 860098125 TRANSPORTATION AND MANUFACTURING OF DAIRY PRODUCTS AZ C 0 VEOLIA TRANSPORTATION SERVICES 2225 N LOWER BUCKEYE ROAD PHOENIX AZ 85009 521493194 CITY BUSY SYSTEM AZ C 0 YOUNG'S MARKET CO OF ARIZONA 624 N 44TH AVE PHOENIX AZ 85043 452501820 WINE AND SPIRITS DISTRIBUTION AZ C 0 UNITED PARCEL SERVICE 55 GLENLAKE PKWY ATLANTA GA 30328 362407381 PARCEL SERVICE GA C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0