2014-02-13T13:19:44-06:00 2013-04-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2012-05-01 946284253 JOINT BENEFIT TRUST JOIN 9254497070 4160 DUBLIN BLVD NO 400 DUBLIN CA 94568 JOHN HURLEY 9254497070 2014-02-13 1 JOSEPH M THIERMANN P01066616 9252779100 2012 2015-11-30 17:44:51Z JOHN HURLEY 4160 DUBLIN BLVD NO 400 DUBLIN CA 94568 100367942 0 X N/A X 1972 CA PROVIDE HEALTH AND WELFARE BENEFITS 8 0 0 0 0 0 0 0 55137507 52129219 257010 161666 3754 899 55398271 52291784 0 0 50646041 44062089 0 0 0 0 0 5937102 5764755 56583143 49826844 -1184872 2464940 23091030 25867177 10231250 10538692 12859780 15328485 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 HEALTH AND WELFARE BENEFITS PROVIDED UNDER COLLECTIVE BARGAINING FOR PARTICIPANTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 481 0 1 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICES & BENEFIT ADMINISTRATORS 9258337300 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 X ASHLEY ALVARADO 2.00 X 0 0 0 JOHN HURLEY 2.00 X 0 0 0 CRESCENCIO DIAZ 2.00 X 0 0 0 RICHARD EHRLER 2.00 X 0 0 0 ADAM OCHOA 2.00 X 0 0 0 RICHARD W MUTO 2.00 X 0 0 0 PABLO BARRERA 2.00 X 0 0 0 TOM NETT 2.00 X 0 0 0 0 0 0 0 0 0 0 HEALTH SERVICES & BENEFIT ADMIN 4160 DUBLIN BLVD SUITE 400 DUBLIN CA 94588 ADMINISTRATOR FEES 3362718 BLUE CROSS OF CALIFORNIA DEPARTMENT 5812 LOS ANGELES CA 900745812 PPO NETWORK FEE 827124 AMERICAN HEALTH WAYS PO BOX 166718 ATLANTA GA 303687180 ADMINISTRATION FEES 466204 THE SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARIAL AND CONSULTING FEES 283416 TRUCKER HUSS 1 EMBARCADERO CENTER 12TH FLOOR SAN FRANCISCO CA 94111 LEGAL FEES 129706 5 EMPLOYER CONTRIBUTIONS 900099 48240683 48240683 EMPLOYEE CONTRIBUTIONS 900099 2726150 2726150 STOP-LOSS RECOVERY 900099 971216 971216 PRESCRIPTION REBATE INCOME 900099 191170 191170 52129219 250118 250118 47987706 48076158 -88452 -88452 -88452 OTHER INCOME 900099 899 899 899 52291784 52130118 0 161666 44062089 3080703 252153 82188 38602 1959068 248930 242 58916 35531 MISC. EXPENSES 8422 49826844 1018808 1138421 4120618 3536787 24991 24662 6966 6966 0 0 17233543 20671937 197700 495370 495370 23091030 25867177 410754 236203 9820496 10302489 10231250 10538692 X 0 0 0 0 12859780 15328485 12859780 15328485 23091030 25867177 2464940 3765 0 X X 0 1 X 1 0 6966 6966 0 0 ACCUMULATED ELIGIBILITY CREDITS 3383489 GROUP INS PREMIUMS PAYABLE 716000 CLAIMS PAYABLE AND IBNR 6203000 10302489 X 52256947 3765 3765 52253182 38602 38602 52291784 49306249 0 49306249 38602 481993 520595 49826844 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 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'S ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGES IN BENEFIT OBLIGATIONS TEAMSTERS ALCOHOL REHABILITATION PROGRAM COMMON TRUSTEES 64274 PAYMENTS FOR PARTICIPATION IN THE PROGRAM. 0 HEALTH SERVICES FOUNDATION COMMON TRUSTEES 1558470 PAYMENTS FOR HEALTH CHECK-UP EXAMINATIONS. 0 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 11 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 AT LEAST ANNUALLY, TRUSTEES AND OTHER INDIVIDUALS SUBJECT TO THE CONFLICT-OF-INTEREST POLICY WILL BE ASKED TO DISCLOSE IN WRITING ANY RELATIONSHIPS OR INTERESTS THAT COULD GIVE RISE TO A CONFLICT. 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 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. HEALTH SERVICES FOUNDATION 160 AIRWAY BOULEVARD LIVERMORE CA 94551 942260587 TO PROVIDE MEDICAL EXAMINATIONS CA 501(C)(4) N/A N/A 0 TEAMSTERS CA STATE COUNCIL OF CANNERY & FOOD PROCESSING UNIONS 1933 W CALDWELL AVENUE VISALIA CA 93277 942801732 LABOR ORGANIZATION CA 501(C)(5) N/A N/A 0 CALIFORNIA PROCESSORS INC 425 MILITARY EAST BENECIA CA 94510 940360771 TO PROVIDE LABOR RELATIONS SERVICES TO MEMBERS OF CPI CA 501(C)(6) N/A N/A 0 TEAMSTERS ALCOHOL REHABILITATION PROGRAM 1620 N CARPENTER ROAD MODESTO CA 95351 942875955 TO PROVIDE GUIDANCE AND REHABILITATION ACTIVITIES CA 501(C)(4) N/A N/A 0 TEAMSTERS LOCAL UNION 948 TEAMSTERS CANNERY WORKERS FOOD PROCESSORS & HELP CONTRIBUTING EMPLOYER 0 CANNERY WAREHOUSEMEN FOOD PROCESSORS DRIVERS AND HELPERS UNION NO 601 CONTRIBUTING EMPLOYER 0 MOTT'S LLP CONTRIBUTING EMPLOYER 0 0 DEL MONTE CORPORATION CONTRIBUTING EMPLOYER 0 CAMPBELL SOUP SUPPLY CO CONTRIBUTING EMPLOYER 0 H J HEINZ COMPANY CONTRIBUTING EMPLOYER 0 HORMEL FOODS CORP CONTRIBUTING EMPLOYER 0 CON AGRA CONTRIBUTING EMPLOYER 0 OASIS FOODS INC CONTRIBUTING EMPLOYER 0 PACIFIC COAST PRODUCERS CONTRIBUTING EMPLOYER 0 UNILEVER SUPPLY CHAIN INC CONTRIBUTING EMPLOYER 0 STANISLAUS FOOD PRODUCTS CONTRIBUTING EMPLOYER 0 SENECA FOODS LLC CONTRIBUTING EMPLOYER 0 CASCADE LOGISTICS CONTRIBUTING EMPLOYER 0 DOLE PROCESSED FOODS CONTRIBUTING EMPLOYER 0 GENERAL MILLS CONTRIBUTING EMPLOYER 0 MOMENTIVE SPECIALTY CHEMICALS INC CONTRIBUTING EMPLOYER 0 NESTLE CORPORATION CONTRIBUTING EMPLOYER 0 REXAM CONTRIBUTING EMPLOYER 0 SILGAN CONTAINER COMPANY CONTRIBUTING EMPLOYER 0 SUN GARDEN CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 TEAMSTERS ALCOHOL REHABILITATION PROGRAM M 64274 PER PARTICIPANT ADMIN FEE HEALTH SERVICES FOUNDATION M 1588470 ANN SVC FEE - APPR BY TRUSTEES