2017-11-15T15:48:12-06:00 2016-12-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2016-01-01 530209136 TEAMSTERS LOCAL 639 EMPLOYERS HEALTH TRUST FUND TEAM 4108729500 3130 AMES PLACE NE WASHINGTON DC 20018 THOMAS RATLIFF TRUSTEE 4108729500 2017-11-15 1 SUBRINA L WOOD CPA P00365899 2023319880 38.100.43.98 2017-11-15 16:47:55 ES P 8F72E301A453F475DDB880747CCED7D2AF7D6D45 28E579D5C84ADB7993B28797CA1155E887E5C41E 2016 2021-01-29 14:40:06Z THOMAS RATLIFF 3130 AMES PLACE NE WASHINGTON DC 20018 184459327 0 X N/A X 1952 DC SEE SCHEDULE O 8 0 0 0 0 0 0 0 44871519 47099737 4388538 2744565 1018 419 49261075 49844721 0 0 33472998 30394722 24000 29474 0 0 0 4136177 4358798 37633175 34782994 11627900 15061727 141912777 162576438 185625 1062083 141727152 161514355 TO PROVIDE COVERAGE FOR HOSPITALIZATION, MEDICAL BENEFITS, MENTAL HEALTH BENEFITS, DISABILITY INCOME, DEATH BENEFITS, PRESCRIPTION DRUGS, DISEASE CASE MANAGEMENT, DENTAL, AND VISION CARE BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 0 0 PAYMENT OF MEDICAL AND OTHER BENEFITS TO OR FOR ITS PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1797 0 1 0 0 0 0 0 0 0 0 0 X 8 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 1 0 0 0 X CARDAY ASSOCIATES 4108739020 7310 COLUMBIA GATEWAY DRIVE SUITE A COLUMBIA MD 21046 ERIC D WEISS CHAIRMAN-EMPLOYER 2.00 2.00 X 12000 20490 0 MICHAEL BULL TRUSTEE-EMPLOYER 2.00 X 12000 0 0 THOMAS RATLIFF SECRETARY-UNION 2.00 40.00 X 0 130457 41847 FRANK W STEGMAN TRUSTEE-EMPLOYER 2.00 2.00 X 0 20490 0 ANTHONY SMITH TRUSTEE-UNION 2.00 40.00 X 0 111820 41847 JOHN GIBSON TRUSTEE-UNION 2.00 40.00 X 0 121139 41847 PHILIP GILES TRUSTEE-UNION 2.00 40.00 X 0 111820 41847 RAYMOND HOWARD TRUSTEE-EMPLOYER 2.00 X 0 0 0 24000 516216 167388 0 0 1 0 CVS CAREMARK INC ONE CVS DRIVE WOONSOCKET RI 02895 PRESCRIPTION BENEFIT MANAGEMENT 7730384 DENTAL HEALTH CENTERS & ASSOCIATES 1450 MERCANTILE LN 131 UPPER MARLBORO MD 20774 DENTAL CLINIC 2608993 CIGNA HEALTHCARE 900 COTTAGE GROVE ROAD BLOOMFIELD CT 06002 CLAIMS PROCESSING 1349605 CARDAY ASSOCIATES 7130 COLUMBIA GATEWAY DR A COLUMBIA MD 21046 THIRD PARTY ADMINISTRATOR 525234 ZENITH AMERICAN SOLUTIONS 10440 LITTLE PATUXENT PKWY COLUMBIA MD 21044 THIRD PARTY ADMINISTRATOR (FORMER) 443651 10 CONTRIBUTIONS-EMPLOYERS 525100 46907763 46907763 CONTRIBUTIONS-PARTICIPANTS 525100 191974 191974 47099737 2770432 2770432 134588739 134614606 -25867 -25867 -25867 SECURITY LITIGATION PROCEEDS 525100 419 419 419 49844721 47100156 0 2744565 30394722 29474 968885 551403 114880 572867 144414 180814 7446 47877 NETWORK PPO FEES 1258767 TRANSITIONAL REINSURANC 270776 OONP EXPENSES 188627 BANK FEES 38466 13576 34782994 -943786 -1822412 15023362 20577388 4444955 5642571 763 0 80126479 89010134 41863024 47074026 1397980 2094731 141912777 162576438 185625 763732 0 298351 185625 1062083 X 141727152 161514355 0 0 0 0 141727152 161514355 141912777 162576438 15061727 4725476 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 16835848 F HEDGE FUNDS 8230035 F REAL ESTATE 22008143 F 47074026 DUES TO BROKER 298351 298351 X 53997330 4725476 4725476 49271854 572867 572867 49844721 34210127 0 34210127 572867 572867 34782994 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AS UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION. THE PLAN ADMINISTRATOR IS NOT AWARE OF ANY UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2016. THE PLAN IS SUBJECT TO ROUTINE AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2013. PART XII, LINE 4B - OTHER ADJUSTMENTS INVESTMENT EXPENSES 572,867 0 0 0 THOMAS RATLIFF SECRETARY-UNION 0 130457 0 0 0 0 0 27432 0 14415 0 172304 0 0 ANTHONY SMITH TRUSTEE-UNION 0 111820 0 0 0 0 0 27432 0 14415 0 153667 0 0 JOHN GIBSON TRUSTEE-UNION 0 121139 0 0 0 0 0 27432 0 14415 0 162986 0 0 PHILIP GILES TRUSTEE-UNION 0 111820 0 0 0 0 0 27432 0 14415 0 153667 0 0 FORM 990, PART I, LINE 1 TO PROVIDE HEALTH & WELFARE INSURANCE BENEFITS TO EMPLOYEES (AND THEIR ELIGIBLE DEPENDENTS) OF CONTRIBUTING EMPLOYERS WHO ARE REPRESENTED BY THE PARTICIPATING LOCAL UNION FORM 990, PART VI, SECTION B, LINE 11B FORM 990 HAS BEEN PROVIDED TO THE FUND'S ADMINISTRATOR TO BE DISTRIBUTED TO THE FUND'S BOARD OF TRUSTESS PRIOR TO ITS FILING FORM 990, PART VI, SECTION B, LINE 12C THE FUND IS SUBJECT TO THE REQUIREMENTS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT, AS AMENDED 1974 ("ERISA"), INCLUDING THE STATUTE'S FIDUCIARY STANDARDS AND PROHIBITED TRANSACTION PROVISIONS, WHICH TOGETHER CONSTITUTE THE FUND'S CONFLICT OF INTEREST POLICY. THE BOARD OF TRUSTEES, ALONG WITH THE VARIOUS FUND PROFESSIONALS' ASSISTANCE, MONITOR AND ENFORCE THE FUND'S COMPLIANCE WITH ERISA AND ALSO THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION C, LINE 19 THE FUND'S ANNUAL FINANCIAL DISCLOSURE STATEMENT, THE FORM 5500, IS AVAILABLE FOR PUBLIC INSPECTION THROUGH CERTAIN WEBSITES, INCLUDING BUT NOT LIMITED TO, THE UNITED STATES DEPARTMENT OF LABOR'S FORM 5500 FILING SEARCH AND FREEERISA. THE FUND MAKES ITS GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS, BENEFICIARIES, THE SPONSORING UNION, AND CONTRIBUTING EMPLOYERS AS REQUIRED BY ERISA. ERISA DOES NOT REQUIRE THE FUND TO MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC AND THE FUND DOES NOT DO SO. TEAMSTERS LOCAL 639 EMPLOYERS PENSION TRUST FUND 3130 AMES PLACE NE WASHINGTON DC 20018 PENSION FUND MD 401(A) 0 TEAMSTERS LOCAL 639 LEGAL SERVICES FUND 3130 AMES PLACE NE WASHINGTON DC 20018 LEGAL FUND MD 501(C)(9) 0 TEAMSTERS LOCAL UNION 639 3130 AMES PLACE NE WASHINGTON DC 20018 LABOR UNION MD 501(C)(5) 0 ABF FREIGHT ADVANTAGE CONF & EXPO ALLIANCE EXPOSITION SERVICES ALUMA SYSTEMS CONCRETE ARATA EXPOSITIONS BOILER & FURNACE BREDE WASHINGTON CLARK CONSTRUCTION COLLINGTON SERVICE ALBERT M BRIGS COMPANY CRANE RENTAL DRIVERS CHAUFFEURS APCOM POWER EL GARDNER EXPO LABOR PROS FREEMAN DECORATING GALLIHER & HUGUELY GES EXPOSITION SERVICE GIANT FOOD HUNGRY MAN PRODUCTIONS HARGROVE INC HERITAGE EXPO HUTCHINSON INTERNATIONAL JJ TAYLOR LAMAR & WALLACE LBM MARTIN-BROWER MARVA MAID MDVA MILK PRODUCERS MERIT CONCRETE METRO MECHANICAL METROPOLITAN POULTRY MONDELEZ INTERNATIONAL NEXXTSHOW NOLAND OTTENBERG'S BAKER NATIONAL EXPO PIERCE ASSOCIATES POTOMAC DISPOSAL SERVICE S FREEDMAN & SONS REPUBLIC NATIONAL DISTRIBUTING CO SAFEWAY STORES SECURITY STORAGE SHENANDOAH'S PRIDE SHEPARD EXPOSITION SILVER HILL MATERIAL SILBER HILL AGGREGATES LTD STROMBERG SUPER CONCRETE TRAX INTERNATIONAL 21ST CENTURY TWP ENTERPRISES TRAVEL COURTS INC UPS WASHINGTON WHOLESALE YRC WORLDWIDE JOINT BOARD OF TRUSTEES LOCAL 639 EMPLOYERS HEALTH 3130 AMES PL NE WASHINGTON DC 20018 530209136 PLAN SPONSOR MD 0 ZENITH AMERICAN SOLUTIONS SHENANDOAH FLEET MAINTENANCE PARAMOUNT CONVENTION SERVICES INC BOURNE 5 PRODUCTIONS BOARD DAYLIGHT LLC EMPLOYCO SERVICES LTD WUW-SACHA KIEWIT ENERGY COMPANY RUAN LOGISTICS CORPORATION SNC-LAVALIN CONSTRUCTION INC TEXAS EXPOSITION SERVICES UNIVERSAL TELEVISION 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1