2022-08-05T14:28:58-05:00 2021-09-30 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE STE 1200W BETHESDA MD 20814 990 2020-10-01 521158708 TEAMSTERS LOCAL 922 - EMPLOYERS HEALTH TRUST TEAM 4108729500 7130 COLUMBIA GATEWAY DRIVE NO A COLUMBIA MD 21046 RUDOLPH GARDNER TRUSTEE 4108729500 2022-07-26 1 RUDOLPH GARDNER 999009999 JOSEPH M HERISHEN CPA P00361968 2023319880 2022-08-05 X 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z RUDOLPH GARDNER 7130 COLUMBIA GATEWAY DRIVE COLUMBIA MD 21406 7287362 0 X N/A X 1979 MD THE FUND PROVIDES MEDICAL,SURGICAL,HOSPITALIZATION, VISION CARE AND DENTAL BENEFITS PURSUANT TO CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 4 4 0 0 24082 0 0 0 6650520 6874537 5534 24082 195700 388743 6851754 7287362 0 0 4315588 6052902 0 0 0 0 0 332156 337900 4647744 6390802 2204010 896560 4165357 4956292 98439 22254 4066918 4934038 NONE 0 0 6390802 THE FUND PROVIDED GROUP LIFE, DISABILITY, HOSPITALIZATION, SURGICAL ,MEDICAL, VISION AND DENTAL BENEFITS TO ELIGIBLE PARTICIPANTS UNDER VARIOUS COLLECTIVE BARGAINING AGREEMENTS. 6390802 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 X CARDAY ASSOCIATES INC 4108729500 7130 COLUMBIA GATEWAY DRIVE STE A COLUMBIA MD 21046 X RUDOLPH GARDNER UNION TRUSTEE 2.00 X 0 0 0 SHERRI DICKERSON EMPLOYER TRUSTEE 2.00 X 0 0 0 TIMOTHY BROWN UNION TRUSTEE 2.00 X 0 0 0 MICHAEL GOBLE EMPLOYER TRUSTEE 2.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS INC 7130 COLUMBIA GATEWAY DR SUITE A COLUMBIA MD 21046 ADMINISTRATIVE 187482 1 EMPLOYER CONTRIBUTIONS 525100 4928271 4928271 PARTICIPANT CONTRIBUTI 525100 1946266 1946266 6874537 24082 24082 PRESCRIPTION REBATE 525100 338714 338714 RX PERFORMANCE GUARANT 525100 49138 49138 SUBROGATION 525100 888 888 3 3 388743 7287362 7263280 24082 0 6052902 6052902 187482 187482 10968 10968 18316 18316 5766 5766 7585 7585 ULTILIZATION REVIEW 51523 51523 PPO FEES 29788 29788 BANK CHARGES 13994 13994 ACTUARIAL 7500 7500 4978 4978 6390802 6390802 0 0 2806548 1418781 809060 2953035 511015 582673 38734 1803 4165357 4956292 98439 22254 98439 22254 X 4066918 4934038 4066918 4934038 4165357 4956292 896560 -29440 0 X 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE TPA PROVIDES A COPY OF THE 990 TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE FINAL FILING. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE AVAILABLE UPON REQUEST.