2023-08-09T15:17:25-05:00 2022-09-30 WITHUMSMITHBROWNPC 4600 EAST WEST HWY 900 BETHESDA MD 208143423 990 2021-10-01 942848389 Teamsters Benefit Trust % TITAN INSURANCE ADMINISTRATO TEAM 5107964676 POST OFFICE BOX 5820 FREMONT CA 94537 KEITH FLEMING TRUSTEE 9252779100 2023-08-04 true KEITH FLEMING 999009999 RICHARD RUVELSON P00234075 3012726000 2021 2023-04-26 12:10:37Z KEITH FLEMING POST OFFICE BOX 5820 FREMONT CA 94537 367435023 false X www.teamstersbenefittrust.com X 1982 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO MULTIEMPLOYER PLAN PARTICIPANTS. 12 0 2 0 1980479 1978682 0 0 330464129 349092236 29565933 14302977 0 4039810 360030062 367435023 0 0 290625391 286711844 0 0 0 0 0 12748300 13411258 303373691 300123102 56656371 67311921 647016311 622468881 40035308 40468503 606981003 582000378 TO PROVIDE HEALTH AND WELFARE BENEFITS TO MULTIEMPLOYER PLAN PARTICIPANTS. false false PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS IN THIS COLLECTIVELY BARGAINED MULTIEMPLOYER TRUST. false false false false false false false false false false true false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 1000 0 true 2 true true true false false false false false false false X 12 0 false true false false false false false true false false false true true true true true true false false false CA X TITAN INSURANCE ADMINISTRATO 5107964676 39420 LIBERTY ST STE 260 FREMONT CA 94538 X William Albanese Trustee 1.0 0.0 X 0 0 0 Rome Aloise Trustee - TERM. 1.31.2022 5.0 0.0 X 0 0 0 Keith Fleming Trustee 5.0 0.0 X 0 0 0 John Bouchard Trustee 1.0 0.0 X 0 0 0 Richard Jordan Trustee 1.0 0.0 X 0 0 0 Dennis Hart Trustee 1.0 0.0 X 0 0 0 Richard Murphy Trustee 1.0 0.0 X 0 0 0 Bill Rossi Trustee 1.0 0.0 X 0 0 0 Bill Hoyt trustee - TERM. 8.10.2021 1.0 0.0 X 0 0 0 Ron Paredes Trustee 1.0 0.0 X 0 0 0 Mike Carnefix Trustee - TERM. 1.31.2022 1.0 0.0 X 0 0 0 Carlos Borba Trustee 1.0 0.0 X 0 0 0 Alberto Ruiz Trustee 1.0 0.0 X 0 0 0 JESSE CASQUEIRO TRUSTEE 1.0 0.0 X 0 0 0 GERALD COLEMAN TRUSTEE 1.0 0.0 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATION 0.0 0.0 X 0 0 0 0 0 0 0 false false false LIPMAN INSURANCE ADMINISTRATORS IN 39420 LIBERTY STREET SUITE 260 FREMONT CA 94538 ADMINISTRATOR 7567873 ANTHEM BLUE CROSS 11030 white rock road rancho cordova CA 95670 ADMINISTRATIVE 809271 Lindquist LLP 5000 Executive Parkway Suite 400 San Ramon CA 94583 Audit Services 507703 Beeson Tayer Bodine ROss House 483 Ninth St 2nd Floor OAKLANd CA 94607 Legal Services 377075 RAEL LETSON 2929 CAMPUS DRIVE SUITE 400 SAN MATEO CA 94403 CONSULTING 255400 11 0 Employer Contributions 900099 330510870 330510870 MEMBER AND RETIREE CONTRIBUTIONS 900099 8511261 8511261 Liquidated Damages 900099 201065 201065 EXPERIENCE-RATED REFUND 900099 9601914 9601914 Medicare Part D Subsidy 900099 308285 308285 -41155 -41155 349092236 14302977 1980479 12322498 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OTHER INCOME 900099 339810 339810 LEGAL SETTLEMENT 900099 3700000 3700000 4039810 367435023 353132050 1980479 12322498 0 0 0 286711844 0 0 0 0 0 0 7825680 309933 559419 0 0 1823752 2230397 0 417651 0 0 0 0 0 28729 0 0 0 207445 Miscellaneous expense 8252 300123102 -984372 2804262 15335856 11266209 0 0 30822817 39582204 0 0 0 0 0 0 0 0 755688 956925 0 0 404230002 384707706 196395120 182690375 0 0 0 0 461200 461200 647016311 622468881 18052395 19887913 0 0 28613 23190 0 0 0 0 0 0 0 0 0 0 21954300 20557400 40035308 40468503 X 0 0 0 0 606981003 582000378 606981003 582000378 647016311 622468881 67311921 -92292546 X X false true X true false LIMITED PARTNERSHIPS 86648595 F 103-12 INVESTMENT ENTITIES 83848860 F LIMITED LIABILITY COMPANY 12192920 F 182690375 0 Accumulated Eligibility Credits 20557400 20557400 X 273318725 -92292546 -92292546 365611271 1823752 1823752 367435023 297857067 297857067 1823752 442283 2266035 300123102 PART XII, LINE 4B - OTHER ADJUSTMENTS: change in benefit obligations PART X, LINE 2 THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF SEPTEMBER 30, 2022, 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. FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH LIPMAN INSURANCE ADMINISTRATORS TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B: THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B: A COPY OF FORM 990 WAS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C: AT LEAST ONCE A YEAR, TRUSTEES AND OTHER FIDUCIARIES SUBJECT TO THE CONFLICT-OF-INTEREST POLICY WILL BE ASKED TO DISCLOSE IN WRITING ANY RELATIONSHIP OR INTERESTS THAT COULD GIVE RISE TO A CONFLICT. SHOULD ANY INDIVIDUAL COVERED BY THE POLICY DETERMINE OR SUSPECT THAT HE OR SHE POSSESSES AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, SUCH INDIVIDUAL MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST OR RELATIONSHIP GIVING RISE TO THE CONFLICT AND DISCLOSE ALL RELEVANT FACTS PRIOR TO ANY DECISION TO ENTER INTO ANY PROPOSED TRANSACTION OR ARRANGEMENT OR, IF LATER, AS SOON AS THE ACTUAL OR POTENTIAL CONFLICT IS RECOGNIZED. THE TRUSTEE OR OTHER FIDUCIARY WITH THE CONFLICT OF INTEREST MUST BE EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION AND THE CONFLICTED INDIVIDUAL IS NOT ALLOWED TO INFLUENCE THE BOARD'S DECISION IN ANY WAY. FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, LIPMAN INSURANCE ADMINISTRATORS. 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. FORM 990, PART V, LINE 2A: THE PLAN DOES NOT HAVE EMPLOYEES. HOWEVER, CERTAIN PARTICIPANTS OF THE PLAN RECEIVED A FORM W-2 FOR TAXABLE DOMESTIC PARTNER BENEFITS. See explanation at Part VII Various CA true false false false false false false false false false false false false false false false false false false false SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF SEPTEMBER 30, 2022, THERE ARE APPROXIMATELY 281 CONTRIBUTING EMPLOYERS AND SPONSORING ORGANIZATIONS. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS AND SPONSORING ORGANIZATIONS, 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. A. TEICHERT & SON, INC. AAK USA RICHMOND CORP ABERCROMBIE PIPELINE SERVICES, LLC ABF FREIGHT SYSTEM, INC ACCO ENGINEERED SYSTEMS ACTION SWEEPING SERVICES, INC ADVANCED CONCRETE ALL MODULAR SYSTEMS ALLIANCE GRAPHICS/MECA ALLIANCE READY MIX, INC ALLIED WASTE ALPHA PRESS, INC. ALSCO AMENTUM SERVICES ANDREINI BROTHERS, INC. APRO INTERNATIONAL ARAMARK UNIFORM SERV ARB - LOCAL 431 ARGENT MATERIALS ARGONAUT CONSTRUCTORS B K MILL & FIXTURE BAKEMARK USA LLC BAUMAN LANDSCAPE, INC. BAY AREA PAVING CO. BAY CITIES PAVING & GRADI BAY CITIES REFUSE SERVICE BAY COUNTIES WASTE SERV BAY VIEW REFUSE & RECYCLI BERONIO LUMBER CO BFI NEWBY ISLAND RECYCLERY BFI-OX MOUNTAIN LANDFILL BLACK POINT PRODUCTIONS BRAGG INVESTMENT CO INC/BRAGG CRANE BROSAMER & WALL-TUTOR PERINI, INC BUBBA'S WATER TRUCK SERVICE, INC C.F. ARCHIBALD PAVING, IN C2G LTD CO CALIF LABOR FED, AFL-CIO CALIF WASTE SOL CALIFORNIA TRADE BINDERY CALMAT CO DBA SHAMROCK CARONE & COMPANY, INC CARPENTER RIGGING LO2785 CEMEX CEN CAL SERVICES CENTRAL CONCRETE SUPPLY C CERUTTI & SONS TRANSPORT CHALLENGE DAIRY PRODUCTS CHANNEL LUMBER CO CHAUFFEURS, TMSTRS & HELP CHERNE CONSTRUCTION CORP CHUCK MACK AND ASSOCIATE CITY OF YAKIMA CONCEPT SERVICES, INC. CONCORD DISPOSAL SERVICE CONSOLIDATED PRINTING CO CONTRA COSTA BUILDING CT COUNTRY HEARTS TOO TRUCKING CURTIN CONVENTION CURTIN THEATRICAL MOVING CZARNOWSKI EXHIBIT D.A.V.E. TRUCKING& SWEEP DALY CITY SCAVENGER CO, I DARLING INTERNATIONAL, IN DELTA SAND GRAVEL & RECYCLING, INC DHL DHL LOCAL 287- H&W DHL LOCAL 912 H & W DINWIDDIE CONSTRUCTION CO DONALD MIRANDA TRUCKING, INC DRAGADOS FLAT IRON JV DRILL TECH DRILLING & SHORING, INC. DUMBARTON QUARRY ASSOCIAT EAGLE DISTRIBUTION EARLE M JORGENSEN CO EAST BAY FORKLIFT EAST BAY RESTAURANT SUPPL EAST BAY SANITARY COMPANY ECONOMY LUMBER CO EMPLOYCO SERVICES, INC ENGEL AND GRAY, INC. EVENT PRODUCTIONS, INC FERMA CORPORATION FERMA GREENBOX, INC. FLOYD JOHNSTON CONST. CO. FOREFRONT DEEP FOUNDATIONS FOSTER FARMS - HAYWARD FOUR M CONTRACTING, INC. FREEMAN EXPOSITIONS,LLC FREMONT UNIVERSAL TRANS G & J HEAVY HAUL G. BORTOLOTTO & COMPANY GALLO SALES COMPANY GARDEN CITY SAN GES, INC GHILOTTI BROTHERS, INC GHILOTTI CONSTRUCTION CO GILLIG CORPORATION GILLIS & LANE, INC GLOBE - BAY AREA FORKLIFT GOLDEN GATE APPAREL ASSOC GOLDEN GATE DISPOS & RECY GOODFELLOW BROS. CA,LLC. GOODLAND LANDSCAPE CONSTRUCTION INC GR4 TRUCKING SERVICE LLC GRANITE CONSTRUCTION CO GRANITE ROCK GREEN TEAM OF SAN JOSE GREGORY CONSTRUCTION EQUIPMENT LLC GREIF BROTHERS CORP GRIFFITH COMPANY GUITTARD CHOCOLATE COMPANY H20 TRANSPORT LLC HALF MOON BAY GRADING & P HANSON AGGREGATES MID-PAC HAROLD SMITH & SONS, INC HENKEL CORPORATION HENKELS & MCCOY, INC HILL BROTHERS CHEMICAL CO IBT IEDA IN TERMINAL SERV INSIGHT EXHIBITS INTERSTATE GRADING & PAVI IOX, LLC J & M, INC. J F C INTERNATIONAL, INC JBS BAKESERVICE JERRY THOMPSON & SONS KATCH ENVIRONMENTAL KIEWIT INFRA WEST CO. KNIFE RIVER CONSTRUCTION KODIAK TRUCKING, INC LARSEN BROS, INC LAWSON DRAYAGE, INC LIPMAN INSURANCE ADMIN LITHOTYPE COMPANY, INC. LUND CONSTRUCTION MAGGIORA & GHILOTTI INC MARIN SANITARY SERVICE MARTIN MARIETTA INC MATERIAL RECOVERY SYSTEMS MATHESON TRI-GAS MAXUM EXPO SERVICES MCGUIRE AND HESTER MICHELS PACIFIC ENERGY MISSION TRAIL WASTE SYSTE MON ROC ADMINISTRATORS MONDELEZ MONTEREY MECHANICAL CO. MOUNTAIN CASCADE INC. NAPA RECYCLING & WASTE NATIONAL CONVENTION SERVICES NO CA TEAMSTERS APP TRAIN NUVISTA EVENT MANAGEMENT SERVICES O C JONES & SONS, INC ODIN CONSTRUCTION O'GRADY PAVING, INC. OLYMPIC PROPERTY SERVICES ON POINT DECORATING, LLC. OPERATING ENGIN. INTERNAT OSBORNE LUMBER CO INC PACIFIC RACING ASSOCIATIO PALMISANO DELIVERY PENINSULA CRANE & RIGGING PINE CONE LUMBER PLANT RECLAMATION PLEASANTON READY MIX POTRERO HILLS LANDFILL PRECISION SWEEPING PREMIUM POWER PRICE STAGE LINE LLC PRODUCTION PAYROLL PYRAMID PAINTING Q & D CONSTRUCTION QLM, INC RANSOME COMPANY RE MASON ENGINEERING INC RECOLOGY - SAN BRUNO GARB RECOLOGY HAY RD LANDFILL RECOLOGY MOUNTAIN VIEW RECOLOGY OF S.M. RECOLOGY OF THE COAST RECOLOGY S.F. RECOLOGY SOUTH VALLEY RECOLOGY VALLEJO REED & GRAHAM REEVE TRUCKING CO RELIANCE SHEET & STRIP CO RELIANCE STEEL & ALUMINUM RELIANCE STEEL & ALUMINUM RENAISSANCE MANAGEMENT REPUBLIC SERVICES (CRP) REYES COCA COLA BOTTLING RICH READIMIX CONCRETE, INC. RICHMOND SANITARY ROMANAZZI GENERAL ENGINEERING ROSSI EXPOSITIONS, INC SA SVG CONTRACTORS SAFEWAY SAN MATEO LUMBER SAN RAFAEL ROCK QUARRY, INC SANTA CLARA CHMBR OF COMM SAVE MART (NEW EMPLOYEES) SAVE MART SUPERMARKETS SCHAWK, INC. SECURITY PAVING CO, INC SERVICE WEST SHEEDY DRAYAGE CO SHELDON GAS SHEPARD EXPOSITION SERV SIERRA MOUNTAIN CONSTR SIERRA POINT LUMBER SIMSMETAL USA SNELSON COMPANIES, INC. SO SAN FRANCISCO SCAVENGE SOLANO SOUTH BAY REC SOUTH CITY LUMBER & SUPP SOUTHERN WINE SPECIALTY SLD WSTE SPER CONTRACTING CORP STATE BUILD & CON TRADE STATEWIDE CONTRACTING OF AMERICA STEVE P RADOS, INC SUKUT CONSTRUCTION LLC SUNSET SCAV CO SYAR SYAR CONCRETE SYSCO SAN FRANCISCO INC. T3 EXPO LLC TDW CONSTRUCTION, INC TEAM GHILOTTI INC. TEAM SAN JOSE-CON & TRADE TEAMSTERS ASSISTANCE PROG TEAMSTERS LO 2010 TEAMSTERS LO 2785 B/A'S TEAMSTERS LO 315 TEAMSTERS LO 350 TEAMSTERS LO 665 TEAMSTERS LO 760 TEAMSTERS LO 853 TEAMSTERS LO 890 TEAMSTERS LOCAL 70 (TEMP ORGANIZER) TEICHERT AGGREGATES LO150 THE GRAND FUND THE GRAND FUND (NO RSP) THE HDD COMPANY, INC TOMMY'S WATER TRUCK RENTL TRAHAN ENTERPRISES TRI-VALLEY WATER TRUCKS TROJAN WARRIOR TRUCKING INC TRUITT & WHITE LUMBER CO TRUNXAI CONSTRUCTION TUTOR-PERINI ZACHARY PARS UNION PAYROLL AGENCY INC UNION PLAZA APARTMENTS UNITED PARADYNE CORPORATI UNITED PARCEL SERV. L.315 UNIVAR SOLUTIONS USA, INC. URBAN ART LITHOGRAPHY VACAVILLE SANITARY SERV VALVERDE CONSTRUCTION VANGUARD CONSTRUCTION VERITIV OPERATING CO VULCAN MATERIALS COMPANY W A RASIC CONSTRUCTION W R FORDE ASSOCIATES WELLS SWEEPING WEST CC SANITARY LANDFILL WEST COUNTY RESOURCE RECO WEST COUNTY RESOURCE RECO WEST VALLEY COLLECTION WEST VALLEY CONSTRUCTION WESTROCK WESTSIDE BUILDING MATERIA WHITE BROTHERS WILLWORK, INC EXHIBIT SER YOUNG'S MARKET 853 FORM78 YOUNGS MARKET LO 70 YRC FREIGHT