2019-08-06T08:41:00-05:00 2018-09-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2017-10-01 942848389 TEAMSTERS BENEFIT TRUST TEAM 5107964676 POST OFFICE BOX 5820 FREMONT CA 94537 KEITH FLEMING TRUSTEE 5107964676 2019-08-06 1 JESSICA R ROSTER P01317380 9252779100 66.7.226.66 2019-08-06 06:40:42 PD P 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2017 2019-02-21 02:37:17Z KEITH FLEMING POST OFFICE BOX 5820 FREMONT CA 94537 376064319 0 X WWW.TEAMSTERSBENEFITTRUST.COM X 1982 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 12 0 2 0 260664 260664 0 0 312110019 319574339 7016069 29328725 0 0 319126088 348903064 0 0 271257152 274822236 0 0 0 0 0 11222792 11339241 282479944 286161477 36646144 62741587 349515385 407860556 36471909 35441757 313043476 372418799 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 X 12 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 KEITH FLEMING TRUSTEE 5.00 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 ROME ALOISE TRUSTEE - PAST 5.00 X 0 0 0 LARRY DAUGHERTY TRUSTEE 1.00 X 0 0 0 DON E GARCIA TRUSTEE 5.00 X 0 0 0 BILL HOYT TRUSTEE 1.00 X 0 0 0 RON PAREDES TRUSTEE 1.00 X 0 0 0 CHRIS SERVI TRUSTEE 1.00 X 0 0 0 CARLOS BORBA TRUSTEE 1.00 X 0 0 0 JEANETTE PAIGE TRUSTEE - PAST 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 6884050 BLUE CROSS 21555 OXNARD STREET AC-1J WOODLAND HILLS CA 91367 COST CONTAINMENT 970240 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDIT SERVICES 401606 BEESON TAYER & BODINE ROSS HOUSE 483 NINTH ST 2ND FLOOR OAKLAND CA 94607 LEGAL SERVICES 296852 RAEL & LETSON 2800 ZAMPUS DRIVE SUITE 150 SAN MATEO CA 94403 CONSULTING SERVICES 254400 9 EMPLOYER CONTRIBUTIONS 900099 306386998 306386998 PARTICIPANT CONTRIBUTIONS 900099 11423775 11423775 MEDICARE PART D SUBSIDY 900099 1506553 1506553 STOP LOSS REFUNDS 900099 165869 165869 LIQUIDATED DAMAGES 900099 91144 91144 319574339 8089980 260664 7829316 48400000 27161255 21238745 21238745 21238745 348903064 319574339 260664 29068061 274822236 6944132 362903 386528 1055888 1979340 316114 24354 106573 MISCELLANEOUS EXPENSE 105082 TRANSITIONAL INSURANCE 58327 286161477 -215843 -809414 11008308 14485638 26423845 27791909 1018403 1093028 185617293 168721781 125202179 196116414 461200 461200 349515385 407860556 13908590 12902564 361819 80393 22201500 22458800 36471909 35441757 X 0 0 0 0 313043476 372418799 313043476 372418799 349515385 407860556 62741587 -3366264 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 187676660 F LIMITED LIABILITY COMPANY 8439754 F 196116414 ACCUMULATED ELIGIBILITY CREDITS 22458800 22458800 X 344480912 -3366264 -3366264 347847176 1055888 1055888 348903064 285768076 0 285768076 1055888 -662487 393401 286161477 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, 2018, 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 2015. 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, 2018, THERE ARE APPROXIMATELY 286 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. 1 STAR ON POINT TRUCKING A S DEZIGN, INC A. TEICHERT & SON, INC. ABC EXPO SERVICES, LLC ABF FREIGHT SYSTEM, INC AECOM ENERGY & CONSTR AIR CONDITIONING CO, INC AKT TRUCKING, LLC ALLIANCE GRAPHICS ALLIED WASTE ALLIED WASTE/ DRIVERS ALPHA PRESS, INC. ALSCO ANDREINI BROTHERS, INC. APOGEE APPLIANCE DELIVERY APRO INTERNATIONAL ARAMARK UNIFORM SERV ARB ARGONAUT CONSTRUCTORS ASHBROOK ENTERPRISES, INC B K MILL & FIXTURE BAKEMARK USA LLC BAUMAN LANDSCAPE, INC BAY AREA PAVING BAY CITIES PAVING & GRADI BAY CITIES REFUSE SERVICE BAY COUNTIES WASTE SERV BERONIO LUMBER CO BERRKELEY FARMS, INC BFI BLACK POINT PRODUCTIONS BLAINE CONVENTION SERVICE BRUCE CARONE GRADING& PAV C.F. ARCHIBALD CAL VALLEY CONSTRUCTION CALIF LABOR FED, AFL-CIO CALIF WASTE SOLUTIONS CALIFORNIA TRADE BINDERY CALMAT CO DBA SHAMROCK CAPS CARONE & CONMPANY CARPENTER RIGGING LO2785 CAST & CREW CEMEX CENTRAL CONCRETE SUPPLY C CERUTTI& SONS TRANSPORT CHALLENGE DAIRY CHANNEL LUMBER CO CHAUFFEURS, TMSTRS & HELP CHERNE CHUCK MACK AND ASSOCIATE CITY OF YAKIMA CONCEPT SERVICES, INC. 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THE GRAND FUND THE HDD COMPANY THOMSON EQUIPMENT COMPANY TOMMY'S WATER TRUCK RENTL TRI VALLEY EXCAVATING CO TRI-CED COMMUNITY RECYCLI TRI-VALLEY WATER TRUCKS TRUITT & WHITE LUMBER CO TRUNXAI CONSTRUCTION TUTOR-SALIBA CORPORATION UNIFIED FIELD SERVICES UNION PAYROLL AGENCY INC UNION PLAZA APARTMENTS UNITED PARADYNE CORPORATION UNITED PARCEL SERV UNIVAR USA INC. URBAN ART LITHOGRAPHY VACAVILLE SANITARY SERV VALVERDE CONSTRUCTION VANGUARD CONSTRUCTION VERITIV OPERATING CO VERITIV OPERATING CO VIDO ARTUKOVICH AND SON VULCAN MATERIALS COMPANY W A RASIC CONSTRUCTION WEST CC SANITARY LANDFILL WEST COUNTY RESOURCE RECO WEST VALLEY COLLECTION WEST VALLEY CONSTRUCTION WESTERN APPLIANCE CO WESTERN EVENT SERVICE WESTROCK WESTSIDE BUILDING MATERIA WHITE BROTHERS WILLWORK, INC EXHIBIT SER WR FORDE YOLANDA'S CONSTRUCTION YOUNG'S MARKET-SALES-#853 YRC FREIGHT