2015-09-15T12:07:41-05:00 2014-11-30 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2013-12-01 866052021 TEAMSTERS WESTERN REGION AND NEW JERSEY HEALTH CARE FUND TEAM 6022493582 2400 W DUNLAP AVENUE PHOENIX AZ 85021 ANDREW MARSHALL TRUSTEE 6022493582 2015-09-11 1 RANDY D HENNINGFIELD P01364367 6612953363 2013 2016-04-25 22:37:26Z ANDREW MARSHALL 1450 S 27 AVENUE PHOENIX AZ 85009 1041269239 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 26544494 790187134 511693 10900800 0 5325566 27056187 806413500 0 0 23066938 218666966 36064 0 0 0 0 2420102 12392371 25523104 231059337 1533083 575354163 15152365 638168189 4366573 49146585 10785792 589021604 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 218666966 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 218666966 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 2088 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 2400 W DUNLAP AVENUE 250 PHOENIZ AZ 85021 X STUART MARCUS 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 RICK MIDDLETON 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 3892290 AETNA PO BOX 14079 LEXINGTON KY 40512 CLAIMS PROCESSING 2402183 SOUTHWEST SERVICE ADMINISTRATORS 2400 W DUNLAP AVE STE 250 PHOENIX AZ 85021 CONTRACT ADMINISTRATOR 1826419 THE SEGAL COMPANY 1230 E WASHINGTON STE 501 TEMPE AZ 85281 CONSULTING 794025 VALUE OPTIONS INC 240 CORPORATE BLVD STE 100 NORFOLK VA 23502 CLAIMS PROCESSING 512076 13 EMPLOYER CONTRIB 480000 789604396 789604396 PARTICIPANT CONTRIB 480000 582738 582738 790187134 6301633 6301633 239454906 234855739 4599167 4599167 4599167 PRESCRIPTION REBATES 480000 4966846 4966846 RETIREE PRESCRIPTION SUBSIDY 480000 182184 182184 STOP LOSS REIMBURSEMENTS 480000 176536 176536 5325566 806413500 795512700 0 10900800 218666966 218666966 1749390 1749390 288082 288082 29051 29051 605263 605263 802122 802122 611055 611055 42846 42846 81722 81722 COST CONTAINMENT FEES 7394501 7394501 ADMINISTRATION - EXTERN 649429 649429 DISABILITY PAYROLL TAXE 98227 98227 PCORI FEES 23000 23000 17683 17683 231059337 218666966 12392371 0 675150 25313690 2649980 1075194 65637125 9533 69190 10742508 547148184 15152365 638168189 1194873 1289910 22348 3171700 47834327 4366573 49146585 X 0 0 0 0 10785792 589021604 10785792 589021604 15152365 638168189 575354163 2881649 0 X 0 1 X 1 0 0 CLAIMS PAYABLE AND IBNR 47664000 PREMIUMS PAYABLE 170327 47834327 808946925 2881649 2881649 806065276 348224 348224 806413500 186048486 0 186048486 348224 44662627 45010851 231059337 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 STUART MARCUS - 1121 124TH AVE NE, BELLEVUE, WA 98005. DOUGLAS RUYGROK - 618 MICHILLINDA AVENUE, ARCADIA, CA XXX-XX-XXXX. ANDREW MARSHALL - 1450 S. 27 AVENUE, PHOENIX, AZ 85009. 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. RICK MIDDLETON - 450 CARSON PLAZA DRIVE, CARSON, CA 90746. 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