2017-09-14T09:53:59-05:00 2016-11-30 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2015-12-01 866052021 TEAMSTERS WESTERN REGION AND NEW JERSEY HEALTH CARE FUND TEAM 6022493582 2550 W UNION HILLS DRIVE SUITE 290 PHOENIX AZ 85027 ANDREW MARSHALL TRUSTEE 6022493582 2017-09-05 1 RANDY D HENNINGFIELD P01364367 6612953363 2015 2021-01-29 14:40:06Z ANDREW MARSHALL 450 CARSON PLAZA DRIVE CARSON CA 90746 681512963 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 542297164 596509699 7940914 30078258 11218483 14341887 561456561 640929844 0 0 435816970 449898436 0 0 0 0 0 22885574 26897209 458702544 476795645 102754017 164134199 739679181 918712707 43858789 42646901 695820392 876065806 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 449898436 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 449898436 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 1828 0 1 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 AZ X SOUTHWEST SERVICE ADMINISTRATORS 6022493582 2550 W UNION HILLS DRIVE STE 290 PHOENIZ AZ 85027 X RICK MIDDLETON TRUSTEE 4.00 X 0 0 0 DOUGLAS RUYGROK TRUSTEE 4.00 X 0 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 RICK HICKS TRUSTEE 4.00 X 0 0 0 DANNY MA TRUSTEE 4.00 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD 8220 N 23RD AVENUE PHOENIX AZ 85021 COST CONTAINMENT FEES/CLAIMS PROCESSING 8567045 AETNA PO BOX 14079 LEXINGTON KY 40512 CLAIMS PROCESSING 5457699 SOUTHWEST SERVICE ADMINISTRATORS 2500 W UNION HILLS DRIVE STE 29 PHOENIX AZ 85027 CONTRACT ADMINISTRATOR 3004405 CAMDEN BONDS PLUS FUND LLC PO BOX 535008 PITTSBURGH PA 15253 INVESTMENT MANAGEMENT 1010780 BEACON HEALTH OPTIONS 240 CORPORATE BLVD STE 100 NORFOLK VA 23502 CLAIMS PROCESSING 963439 16 EMPLOYER CONTRIB 480000 593405232 593405232 PARTICIPANT CONTRIB 480000 3104467 3104467 596509699 18778045 18778045 51883332 40583119 11300213 11300213 11300213 PRESCRIPTION REBATES 480000 14287778 14287778 STOP LOSS REIMBURSEMENTS 480000 54109 54109 14341887 640929844 610851586 0 30078258 449898436 449898436 2901974 2901974 192210 192210 98488 98488 2416632 2416632 293954 293954 730057 730057 65586 65586 127137 127137 COST CONTAINMENT FEES 16482561 16482561 REINSURANCE FEES 1651892 1651892 ADMINISTRATION - EXTERN 1388757 1388757 DISABILITY PAYROLL TAXE 400729 400729 147232 147232 476795645 449898436 26897209 0 62014343 29277558 54846601 57579238 62049 62557 622756188 831793354 739679181 918712707 1471596 2332203 0 241251 42387193 40073447 43858789 42646901 X 0 0 0 0 695820392 876065806 695820392 876065806 739679181 918712707 164134199 16111215 0 X 0 1 X 1 0 0 CLAIMS PAYABLE AND IBNR 44394000 PREMIUMS PAYABLE -4320553 40073447 655076692 16111215 16111215 638965477 1964367 1964367 640929844 477145024 0 477145024 1964367 -2313746 -349379 476795645 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 11 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 RICK MIDDLETON - 450 CARSON PLAZA DRIVE, CARSON, CA 90746. DOUGLAS RUYGROK - 618 MICHILLINDA AVENUE, ARCADIA, CA XXX-XX-XXXX. ANDREW MARSHALL - 450 CARSON PLAZA DRIVE, CARSON, CA 90746. B.J. DORFMAN - 55 GLENLAKE PKWY, ATLANTA, GA 30328. CHRIS LANGAN - 55 GLENLAKE PKWY, ATLANTA, GA 30328. ALFRED BETTS - 282 HILLSIDE AVE, HILLSIDE, NY 07205. RICK HICKS - 14675 INTERURBAN AVE S, TUKWILA, WA 98168. DANNY MA - 20227 N 27TH AVENUE, PHOENIX, AZ 85027. 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