2013-05-24T12:47:41-05:00 2012-07-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2011-08-01 946072965 BAY AREA DELIVERY DRIVERS SECURITY FUND BAYA 9258337300 400 DUBLIN BLVD STE 400 DUBLIN CA 94568 JACK BOOKTER 4154670450 2013-05-24 1 DEBBIE R DIMERY P01065763 9252779100 2011 2016-03-07 17:11:31Z JACK BOOKTER 400 DUBLIN BLVD STE 400 DUBLIN CA 94568 34363755 0 X N/A X 1950 CA TO PROVIDE HEALTH AND WELFARE BENEFITS 6 1 0 0 0 0 0 0 32454284 34355600 4705 8155 0 0 32458989 34363755 0 0 28587626 30958686 0 0 0 0 0 1060012 1161077 29647638 32119763 2811351 2243992 9829066 13025716 5043851 5996509 4785215 7029207 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 0 0 1 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 0 1 1925 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 617126 BLUE CROSS OF CALIFORNIA 700 BROADWAY DENVER CO 80273 COST CONTAINMENT 175792 2 EMPLOYER CONTRIBUTIONS 900099 32958159 32958159 STOP LOSS REFUNDS 900099 689870 689870 REBATES AND REFUNDS 900099 246209 246209 MEDICARE DRUG SUBSIDY 900099 241475 241475 PARTICIPANT CONTRIBUTI 900099 214166 214166 5721 5721 34355600 8155 8155 34363755 34355600 0 8155 30958686 604222 55584 39534 357787 69078 9062 25800 FILING FEE 10 32119763 2662928 3248479 2004383 4512410 3179891 3272571 29718 4644 1269972 1270100 682174 717512 9829066 13025716 106851 108509 4937000 5888000 5043851 5996509 X 0 0 0 0 4785215 7029207 4785215 7029207 9829066 13025716 2243992 0 X X 0 1 1 X 0 0 MUTUAL FUNDS 1270100 F 1270100 DEPOSITS-KAISER 717512 717512 CLAIMS PAYABLE AND IBNR 3064000 PREMIUMS PAYABLE 750000 ACCUMULATED ELIGIBILITY CREDITS 2074000 5888000 34363755 32119763 2243992 951000 951000 3194992 34363755 0 34363755 0 34363755 31168763 0 31168763 951000 951000 32119763 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PLAN'S ADMINISTRATORS HAVE ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAVE CONCLUDED THAT, AS OF JULY 31, 2012, 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 YEARS PRIOR TO JULY 31, 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS PART XIII, 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 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, 2012, THERE ARE APPROXIMATELY 20 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED TO BE REPORTED ON SCHEDULE R, SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER, IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.