2014-06-03T12:49:10-05:00 2013-07-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2012-08-01 946072965 BAY AREA DELIVERY DRIVERS SECURITY FUND BAYA 9258337300 400 DUBLIN BLVD NO 400 DUBLIN CA 94568 JACK BOOKTER 4154670450 2014-06-03 1 DEBBIE ROESSL DIMERY P01065763 9252779100 2012 2015-11-30 17:44:51Z JACK BOOKTER 400 DUBLIN BLVD NO 400 DUBLIN CA 94568 33708250 0 X N/A X 1950 CA TO PROVIDE HEALTH AND WELFARE BENEFITS 6 1 0 0 0 0 0 0 34355600 33696361 8155 11889 0 0 34363755 33708250 0 0 30958686 30342171 0 0 0 0 0 1161077 1176283 32119763 31518454 2243992 2189796 13025716 15357345 5996509 6138342 7029207 9219003 PROVIDE HEALTH AND WELFARE BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 1 0 0 1 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 1 0 0 1 1924 1 1 0 0 0 0 0 0 0 X 6 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICES & BENEFIT ADMIN 9258337300 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94551 X JACK BOOKTER 1.00 X 0 0 0 DENNIS HART 1.00 X 0 0 0 LINDSAY MARSHALL 1.00 X 0 0 0 FRANK CADEMARTI 1.00 X 0 0 0 DEBBIE FIELD 1.00 X 0 0 0 RICHARD RODRIGUEZ 1.00 X 0 0 0 0 0 0 0 0 0 0 HEALTH SERVICES & BENEFIT ADMINISTRATORS 4160 DUBLIN BLVD STE 400 DUBLIN CA 94568 PLAN ADMINISTRATOR 666959 BLUE CROSS OF CALIFORNIA 700 BROADWAY DENVER CO 80273 COST CONTAINMENT 181664 2 EMPLOYER CONTRIBUTIONS 900099 32591034 32591034 STOP LOSS REFUNDS 900099 376973 376973 REBATES AND REFUNDS 900099 275486 275486 MEDICARE DRUG SUBSIDY 900099 245750 245750 PARTICIPANT CONTRIBUTIONS 900099 205320 205320 1798 1798 33696361 11889 11889 33708250 33696361 0 11889 30342171 631470 37025 32581 387512 56867 5038 24691 MISCELLANEOUS EXPENSE 1099 31518454 3248479 2009425 4512410 8024167 3272571 3330763 4644 5247 1270100 1270231 717512 717512 13025716 15357345 108509 118342 5888000 6020000 5996509 6138342 X 0 0 0 0 7029207 9219003 7029207 9219003 13025716 15357345 2189796 0 X X 0 1 X 1 0 0 MUTUAL FUNDS 1270231 F 1270231 CLAIMS PAYABLE AND IBNR 3146000 PREMIUMS PAYABLE 770000 ACCUMULATED ELIGIBILITY CREDITS 2104000 6020000 X 33708250 0 33708250 0 33708250 31386454 0 31386454 132000 132000 31518454 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE PLAN'S ADMINISTRATORS HAVE ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAVE CONCLUDED THAT, AS OF JULY 31, 2013, 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 BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH HEALTH SERVICES & BENEFIT ADMINISTRATORS INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. 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. REVIEW OF THE FORM 990 WAS CONDUCTED BY THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE MEMBERS OF THE BOARD OF TRUSTEES DISCLOSE ANY CONFLICTS WHEN THEY ARE PROVIDED THE FORM 990, BEFORE IT IS FILED. THE POLICY IS CONSISTENTLY MONITORED AND ENFORCED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL INFORMATION AVAILABLE TO THE PARTICIPANTS AND CONTRIBUTING EMPLOYERS. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. RETAIL DELIVERY DRIVERS SALESMEN & HELPERS UNION LOCAL 278 940801849 PLAN SPONSOR CA 501 (C) (5) N/A N/A 0 SEE EXPLANATION AT PART VII VARIOUS CA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIBILE EMPLOYEES AND THEIR DEPENDENTS. AS OF JULY 31, 2013, THERE ARE APPROXIMATELY 15 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW, AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. TEAMSTERS LOCAL #2785 DS WATERS OF AMERICA HILLS PET NUTRITION R.A. DE LUCA FOOD SERVICE UNITED PARCEL SERVICE ELWELL TRUCKING, INC. HOME MAID RAVIOLI KING AMERICAN AMBULANCE RON'S MEDICAL GASES, INC. RUAN TRANSPORT CORP. INSHALAH IMPORTS INC. TWO G'S CATERING, INC. FOOD SERVICE PARTNERS WILCOX FROZEN FOODS, INC. HS&BA