2021-08-09T13:46:22-05:00 2020-09-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2019-10-01 942848389 TEAMSTERS BENEFIT TRUST TEAM 5107964676 POST OFFICE BOX 5820 FREMONT CA 94537 KEITH FLEMING TRUSTEE 5107964676 2021-08-09 1 JESSICA R ROSTER P01317380 9252779100 2019 2022-09-23 18:48:47Z KEITH FLEMING POST OFFICE BOX 5820 FREMONT CA 94537 337741506 0 X WWW.TEAMSTERSBENEFITTRUST.COM X 1982 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 13 0 2 0 83490 82490 0 0 329085443 327670582 9753913 10070924 0 0 338839356 337741506 0 0 297092359 289734163 0 0 0 0 0 12205135 12902780 309297494 302636943 29541862 35104563 451609321 515238654 37694661 37781871 413914660 477456783 TO PROVIDE HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO 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 1000 0 1 2 1 1 1 0 0 0 0 0 0 0 X 13 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X LIPMAN INSURANCE ADMINISTRATORS INC 5107964676 39420 LIBERTY ST SUITE 260 FREMONT CA 94538 X WILLIAM ALBANESE TRUSTEE 1.00 X 0 0 0 ROME ALOISE TRUSTEE 5.00 X 0 0 0 KEITH FLEMING TRUSTEE 5.00 X 0 0 0 JOHN BOUCHARD TRUSTEE 1.00 X 0 0 0 RICHARD JORDAN TRUSTEE 1.00 X 0 0 0 DENNIS HART TRUSTEE 1.00 X 0 0 0 RICHARD MURPHY TRUSTEE 1.00 X 0 0 0 BILL ROSSI TRUSTEE 1.00 X 0 0 0 LARRY DAUGHERTY TRUSTEE - PAST 1.00 X 0 0 0 DON E GARCIA TRUSTEE - PAST 5.00 X 0 0 0 BILL HOYT TRUSTEE 1.00 X 0 0 0 RON PAREDES TRUSTEE 1.00 X 0 0 0 MIKE CARNEFIX TRUSTEE 1.00 X 0 0 0 CARLOS BORBA TRUSTEE 1.00 X 0 0 0 ALBERTO RUIZ TRUSTEE 1.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 1 0 0 1 0 0 0 0 0 LIPMAN INSURANCE ADMINISTRATORS INC 39420 LIBERTY STREET SUITE 260 FREMONT CA 94538 ADMINISTRATOR 7199952 BLUE CROSS 21555 OXNARD STREET AC-1J WOODLAND HILLS CA 91367 COST CONTAINMENT 769096 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDIT SERVICES 363272 BEESON TAYER & BODINE ROSS HOUSE 483 NINTH ST 2ND FLOOR OAKLAND CA 94607 LEGAL SERVICES 271638 RAEL & LETSON 2929 CAMPUS DR STE 400 SAN MATEO CA 94403 CONSULTING 264000 11 EMPLOYER CONTRIBUTIONS 900099 315428529 315428529 PARTICIPANT CONTRIBUTIONS 900099 10561518 10561518 MEDICARE PART D SUBSIDY 900099 1089537 1089537 LIQUIDATED DAMAGES 900099 457778 457778 STOP LOSS REFUNDS 900099 133220 133220 327670582 10070924 83490 9987434 337741506 327670582 83490 9987434 289734163 7303343 338704 449511 1992359 2005684 395405 42517 135262 MISCELLANEOUS EXPENSE 239995 302636943 -877457 -914165 13133935 10710401 27311931 30906369 989804 794023 178662415 295721794 231927493 177559032 461200 461200 451609321 515238654 14364653 16831972 298608 46299 23031400 20903600 37694661 37781871 X 0 0 0 0 413914660 477456783 413914660 477456783 451609321 515238654 35104563 28437560 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 165486261 F LIMITED LIABILITY COMPANY 12072771 F 177559032 ACCUMULATED ELIGIBILITY CREDITS 20903600 20903600 X 364186707 28437560 28437560 335749147 1992359 1992359 337741506 300358822 0 300358822 1992359 285762 2278121 302636943 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, 2020, 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 2017. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 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 1 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 ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF SEPTEMBER 30, 2020, THERE ARE APPROXIMATELY 251 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. ABF FREIGHT SYSTEM, INC AIR CONDITIONING CO, INC ALLIANCE GRAPHICS/MECA ALLIANCE READY MIX, INC ALLIED WASTE ALPHA PRESS, INC. ALSCO ANDREINI BROTHERS, INC. APRO INTERNATIONAL ARAMARK UNIFORM SERV ARB - LOCAL 431 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 BERKELEY FARMS BERONIO LUMBER CO BFI NEWBY ISLAND REC. BFI-OX MOUNTAIN LANDFILL BLACK POINT PRODUCTIONS BLAINE CONVENTION SERVICE BUBBA'S WATER TRUCK SERVICE, INC C.F. ARCHIBALD PAVING, IN CALIF LABOR FED, AFL-CIO CALIF WASTE SOLUTIONS CALIFORNIA TRADE BINDERY CALMAT CO DBA SHAMROCK CAPS CARONE & COMPANY, INC CARPENTER RIGGING LO2785 CAST & CREW CEMEX CEN CAL SERVICES CENTRAL CONCRETE SUPPLY C CERUTTI& SONS TRANSPORT CHALLENGE DAIRY PRODUCTS CHANNEL LUMBER CO CHAUFFEURS, TMSTRS & HELP 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 DHL DINWIDDIE CONSTRUCTION CO DONALD MIRANDA TRUCKING, INC DRAGADOS FLAT IRON JV 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. EP PROD EVENT PRODUCTIONS, INC FERMA CORPORATION FERMA GREENBOX, INC. FILM COMMERCIALS FLOYD JOHNSTON CONST. CO. FOREFRONT DEEP FOUNDATIONS FOSTER FARMS - HAYWARD FREEMAN EXPOSITIONS,LLC FREMONT UNIVERSAL TRANS G & J HEAVY HAUL G&C/APS JOINT VENTURE G. BORTOLOTTO & COMPANY GALLO SALES COMPANY GARDEN CITY SAN-CLERICAL 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. GRANITE CONSTRUCTION CO GREEN TEAM OF SAN JOSE GREIF BROTHERS CORP HALF MOON BAY GRADING & P HANSON AGGREGATES MID-PAC HAROLD SMITH & SONS, INC HILL BROTHERS CHEMICAL CO IBT IEDA IN TERMINAL SERV (GATE) INSIGHT EXHIBITS INTERSTATE GRADING & PAVI IOX, LLC J & M, INC. J F C INTERNATIONAL, INC JARRETT, 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 MATERIAL RECOVERY SYSTEMS MATHESON TRI-GAS MAXUM EXPO SERVICES MCGUIRE AND HESTER MEDIA SERVICES MICHELS PIPELINE CONSTR MISSION TRAIL 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 - HRLY PATTERSON HEAVY HAUL PENINSULA CRANE & RIGGING PINE CONE LUMBER PLANT RECLAMATION PLEASANTON READY MIX POTRERO HILLS LANDFILL PRODUCTION PAYROLL PYRAMID PAINTING Q & D CONSTRUCTION RANSOME COMPANY RECOLOGY REED & GRAHAM RELIANCE SHEET & STRIP CO RELIANCE STEEL & ALUMINUM RENAISSANCE MANAGEMENT REPUBLIC SERVICES (CRP) REVOLUTION PAYROLL REYES COCA COLA BOTTLING RICH READIMIX CONCRETE, INC. RICHMOND SANITARY SAFEWAY,INC. SAN FRANCISCO EXPO SERV SAN MATEO LUMBER SAN RAFAEL ROCK QUARRY, INC SANTA CLARA CHMBR OF COMM SAVE MART SUPERMARKETS SCHAWK, INC. SECURITY PAVING CO, INC SERVICE WEST SF CHRONICLE-DRIVERS 921 SHEEDY DRAYAGE CO SHELDON GAS SHEPARD EXPOSITION SERV SIERRA MOUNTAIN CONSTR SIERRA POINT LUMBER SIMSMETAL USA SNELSON COMPANIES, INC. SO SAN FRANCISCO SCAVENGE SOLANO GARBAGE - DRIVERS SOLANO RECYCLES SOUTH BAY REC SOUTH CITY LUMBER & SUPP SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS (CONT'D): SOUTHERN WINE SPECIALTY SOLID WASTE & R SPER CONTRACTING CORP STATE BUILD & CON TRADE STATEWIDE CONST SWEEPING STEVE P RADOS, INC STL TRUCKING, LLC SUGAR CITY BUILDING MATER SUNSET SCAV CO CLER UNIT SYAR CONCRETE SYAR INDUSTRIES, INC. 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 287 TEAMSTERS LO 315 TEAMSTERS LO 350 TEAMSTERS LO 665 TEAMSTERS LO 760 TEAMSTERS LO 853 TEAMSTERS LO 890 TEAMSTERS LO 912 TEICHERT AGGREGATES LO150 THE GRAND FUND THE HDD COMPANY, INC TOMMY'S WATER TRUCK RENTL TRAHAN ENTERPRISES TRI-CED COMMUNITY RECYCLI TRI-VALLEY WATER TRUCKS TRUITT & WHITE LUMBER CO TRUNXAI CONSTRUCTION TUTOR-PERINI ZACHARY PARS UNION PAYROLL AGENCY INC UNION PLAZA APARTMENTS UNITED PARADYNE CORPORATI UNITED PARCEL SERV 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 VALLEY COLLECTION WEST VALLEY CONSTRUCTION WESTERN APPLIANCE CO WESTROCK WESTSIDE BUILDING MATERIA WHITE BROTHERS WILLWORK, INC EXHIBIT SER YOUNG'S MARKET YRC FREIGHT