2015-05-12T13:50:46-05:00 2014-09-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2013-10-01 942848389 TEAMSTERS BENEFIT TRUST TEAM 5107964676 POST OFFICE BOX 5820 FREMONT CA 94537 ROME ALOISE TRUSTEE 5107964676 2015-05-12 1 JESSICA R ROSTER P01317380 9252779100 2013 2016-03-07 17:11:31Z ROME ALOISE POST OFFICE BOX 5820 FREMONT CA 94537 367597979 0 X WWW.TEAMSTERSBENEFITTRUST.COM X 1982 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 14 0 6 0 0 0 0 0 262920598 278637908 5629729 5678721 10168 5627 268560495 284322256 0 0 236706254 251515692 0 0 0 0 0 8870111 9162126 245576365 260677818 22984130 23644438 197112848 231422836 33891699 34186340 163221149 197236496 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 2008 0 1 6 1 0 0 0 0 0 0 X 14 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 JEANETTE PAIGE 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 5.00 X 0 0 0 CARLOS BORBA TRUSTEE 1.00 X 0 0 0 ROBERT MORALES TRUSTEE 1.00 X 0 0 0 BILL HOYT TRUSTEE 1.00 X 0 0 0 RON PAREDES TRUSTEE 1.00 X 0 0 0 DON E GARCIA TRUSTEE 1.00 X 0 0 0 CHRIS SERVI TRUSTEE 1.00 X 0 0 0 SAM ROSAS TRUSTEE 1.00 X 0 0 0 DALE ROBBINS 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 5865503 BLUE CROSS 21555 OXNARD STREET AC-1J WOODLAND HILLS CA 91367 COST CONTAINMENT 610165 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDIT SERVICES 326837 TEAMSTERS ASSISTANCE PROGRAM 300 PENDLETON WAY OAKLAND CA 946212109 EMPLOYEE ASSISTANCE SERVICES 244060 BEESON TAYER & BODINE ROSS HOUSE 483 NINTH ST 2ND FLOOR OAKLAND CA 94607 LEGAL SERVICES 242401 10 EMPLOYER CONTRIBUTIONS 900099 260636835 260636835 PARTICIPANT CONTRIBUTIONS 900099 13795013 13795013 EXPERIENCE RATED REFUNDS 900099 2774526 2774526 MEDICARE PART D SUBSIDY 900099 1043721 1043721 STOP LOSS REFUNDS 900099 352718 352718 35095 35095 278637908 3959931 3959931 84994513 83275723 1718790 1718790 1718790 OTHER INCOME 900099 5627 5627 5627 284322256 278643535 0 5678721 251515692 6046970 242770 315666 227816 1701289 343168 40028 69736 MISCELLANEOUS EXPENSE 174683 260677818 -356627 -831109 9558879 10390299 22239250 23372044 945613 946418 133000906 123716573 31263627 73367411 461200 461200 197112848 231422836 14258192 13420313 197507 391227 19436000 20374800 33891699 34186340 X 0 0 0 0 163221149 197236496 163221149 197236496 197112848 231422836 23644438 10370909 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 73367411 F 73367411 ACCUMULATED ELIGIBILITY CREDITS 20374800 20374800 X 294465349 10370909 10370909 284094440 227816 227816 284322256 260293185 0 260293185 227816 156817 384633 260677818 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, 2014, 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 2011. 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 11 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: 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 ORGANIZATIONS. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, LIPMAN INSURANCE ADMINISTRATORS, INC. 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 0 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, 2014, THERE ARE APPROXIMATELY 325 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 AGUILAR TRUCKING AIR CONDITIONING CO, INC AIR LIQUIDE AMERICA CORP ALB, INC ALLIANCE GRAPHICS/MECA ALLIED BOX & EXCELSIOR ALLIED WASTE ALLIED WASTE - TNSFR DRVS ALLIED WASTE/GARBAGE COLL ALPHA PRESS, INC. ALSCO ALTA WESTSIDE BLDG MAT ANDREINI BROTHERS, INC. ANGELO UTILITIES ANNUZZI'S CONCRETE SERV. ANOZIRA, INC. ARAMARK UNIFORM SERV ARATA EXPOSITIONS, INC ARB ARGONAUT CONSTRUCTORS AZCO, INC B K MILL & FIXTURE BAE SYS SF SHIP REPAIR BAKEMARK USA LLC BAUMAN LANDSCAPE, INC. BAY AREA PAVING CO. BAY AREA TRAFFIC SOLUTION BAY CITIES PAVING & GRADI BAY CITIES REFUSE SERVICE BAY COUNTIES WASTE SERV BAY VIEW REFUSE & RECYCLI BERKELEY FARMS BERONIO LUMBER CO BFI-OX MOUNTAIN LANDFILL BLACK POINT PRODUCTIONS BLAINE CONVENTION SERVICE BRANNON EQUIP AND LEASING BRIDGFORD FOODS CORP BRODHEAD STEEL PRODUCTS BRUCE CARONE GRADING& PAV BRW USA, LLC C.F. 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INTERNAT OSBORNE LUMBER CO INC PACIFIC RACING ASSOCIATIO PALMISANO DELIVERY - MO PAR ELECTRICAL CONTRACTOR PATTERSON HEAVY HAUL PAYCHEX / TWITCH FILMS PAYEES / BIG SUR PROD PDEI / DETOUR NETWORK PENINSULA CRANE & RIGGING PERFORMANCE EQUIPMENT PERFORMANCE MECHANICAL PES / XLERATOR MEDIA PIAZZA CONSTRUCTION PINE CONE LUMBER PLEASANTON READY MIX POTRERO HILLS LANDFILL PREMEDIA SYSTEMS, INC. PS SERVICES PYRAMID PAINTING QUALITY TERMINAL SERVICE R & M PAVING CONTRACTORS R E SERRANO, INC R L DODGE CONSULTING RANSOME COMPANY RECOLOGY HAY RD RECOLOGY OF S.M. RECOLOGY OF THE COAST RECOLOGY VALLEJO RECOLOGY WASTE ZERO REED & GRAHAM OILSPREADER REEVES & PENDERGAST CONST RELIANCE SHEET & STRIP CO RELIANCE STEEL & ALUMINUM RENAISSANCE MANAGEMENT RGW EQUIPMENT SALES, LLC RICH READY MIX CONCRETE RICHMOND SANITARY SERVICE ROCKTENN ROGERS TRUCKS & EQUIPMENT RYAN ENGINEERING, INC. S F REC & DISP TRAN ST SAFEWAY,INC. SAN BRUNO GARBAGE COMPANY SAN FRANCISCO EXPO SERV SAN FRANCISCO GRAVEL COMP SAN JOSE MERCURY NEWS SAN MATEO LUMBER SAN RAFAEL ROCK QUARRY, I SANTA CLARA CHMBR OF COMM SAVE MART SUPERMARKETS SCHAWK, INC. SECURITY PAVING CO, INC SERVICE WEST - THEATRICAL SF CHRONICLE-DRIVERS SHAMROCK MATERIALS, INC. SHEEDY DRAYAGE CO SHELDON GAS SHEPARD EXPOSITION SERV SIERRA POINT LUMBER HOURL SIMSMETAL USA SKANSKA/SHIMMIC/HERZOG/JV SNELSON COMPANIES, INC. SO SAN FRANCISCO SCAVENGE SOLANO GARBAGE SOLANO RECYCLES SOUTH BAY REC SOUTH CITY LUMBER & SUPPL SOUTH VALLEY DISPOSAL CO SOUTHERN WINE & SPIRITS SOUTHLAND TUTOR PERINI JV SPECIALIZED WATER SERV SPECIALTY SLD WSTE STAGE CALL, INC STATE BUILD & CON TRADE STEVE P RADOS, INC STICH CONSTRUCTION STICH CONSTRUCTION, INC SUGAR CITY BUILDING MATER SUNSET SCAVENGER COMPANY SWEEPIT SYAR CONCRETE SYAR INDUSTRIES, INC. SYNERGY PROJECT MGNT, INC SYSCO SAN FRANCISCO INC. T & M WATER TRUCK SERVICE T3 EXPO LLC TACKETT'S WATER SERVICE TEAM / SIR ZIP STUDIOS TEAM GHILOTTI INC. TEAM SAN JOSE TEAMSTERS ASSISTANCE PROG TEAMSTERS LO 2010 TEAMSTERS LO 2785 TEAMSTERS LO 287 TEAMSTERS LO 315 TEAMSTERS LO 350 TEAMSTERS LO 665 TEAMSTERS LO 853 TEAMSTERS LO 890 TEAMSTERS LO 912 TEAMSTERS LO 986 TEAMSTERS LOCAL 760 TEAMSTERS TRAINING TRUST TEICHERT AGGREGATES TEICHERT READY MIX TELFER OIL CO. TETRA TECH EC, INC. SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS - CONTINUED: THE GRAND FUND THE HDD COMPANY, INC THE UNISOURCE CORPORATION TRI-CED COMMUNITY RECYCLI TRUITT & WHITE LUMBER CO TRUNXAI CONSTRUCTION TUCKER ENGINEERING, INC TUTOR-SALIBA CORPORATION UNION PAYROLL AGENCY INC UNION PLAZA APARTMENTS UNITED PARADYNE CORPORATI UNITED PARCEL SERV. UNIVAR USA INC. 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