2014-11-14T18:25:59-06:00 2013-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990 2013-01-01 931207916 DAIMLER TRUCKS NA LLC PORTLAND SHOP EMPLOYEE BENEFIT TRUST DAIM 5037458479 2701 NW VAUGHN ST NO 900 PORTLAND OR 97210 MICHAEL KURUC DIRECTOR OF TAXES 5037458479 2014-11-07 1 WENDY CAMPOS P00448102 5032421447 2013 2015-11-30 17:44:51Z MICHAEL KURUC 2701 NW VAUGHN ST NO 900 PORTLAND OR 97210 10229465 0 X N/A X 1976 OR VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. 6 6 0 15 0 0 0 0 11272258 10229185 326 280 0 0 11272584 10229465 0 0 10590693 10003354 0 0 0 0 0 333440 335428 10924133 10338782 348451 -109317 1558325 1465231 7233 23456 1551092 1441775 VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. 0 0 PROVIDE MEDICAL BENEFITS TO ACTIVE UNION EMPLOYEES. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 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 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X ERIK LINVOG 5037458479 2701 NW VAUGHN ST SUITE 900 PORTLAND OR 97210 X JOHN O'LEARY CHAIR, MEMBER 0.50 X X 0 0 0 BRIAN BURTON MEMBER 0.50 X 0 0 0 ROGER NIELSEN MEMBER 0.50 X 0 0 0 KELLEY PLATT MEMBER 0.50 X 0 0 0 BOB ROBERTSON MEMBER 0.50 X 0 0 0 DAVID SWAINSON MEMBER 0.50 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD 600 E LAFAYETTE BLVD DETROIT MI 48226 CONTRACT ADMINISTRATOR 190228 1 CONTRIBUTIONS 525100 10229185 10229185 10229185 279 279 1 0 1 1 1 10229465 10229185 0 280 10003354 17237 318191 10338782 1558237 1465220 88 11 1558325 1465231 7233 23456 7233 23456 X 1551092 1441775 0 0 0 0 1551092 1441775 1558325 1465231 -109317 0 X 0 1 X 1 0 0 X PART X, LINE 2: IN ACCORDANCE WITH GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, THE PLAN ADMINISTRATOR EVALUATED THE PLAN'S TAX POSITIONS AND DOES NOT BELIEVE THE PLAN HAS ANY UNCERTAIN TAX POSITIONS THAT REQUIRE DISCLOSURE OR ADJUSTMENT TO THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2010. FORM 990, PART VI, SECTION A, LINE 2 ROGER NIELSEN IS RELATED TO ALL OTHER MEMBERS OF THE INVESTMENT COMMITTEE THROUGH A BUSINESS RELATIONSHIP. ALL INVESTMENT COMMITTEE MEMBERS ARE EMPLOYED BY DAIMLER TRUCKS NORTH AMERICA, THE SPONSOR OF THE BENEFIT PLAN AND TRUST. JOHN O'LEARY IS RELATED TO ALL OTHER MEMBERS OF THE INVESTMENT COMMITTEE THROUGH A BUSINESS RELATIONSHIP. ALL INVESTMENT COMMITTEE MEMBERS ARE EMPLOYED BY DAIMLER TRUCKS NORTH AMERICA, THE SPONSOR OF THE BENEFIT PLAN AND TRUST. BRIAN BURTON IS RELATED TO ALL OTHER MEMBERS OF THE INVESTMENT COMMITTEE THROUGH A BUSINESS RELATIONSHIP. ALL INVESTMENT COMMITTEE MEMBERS ARE EMPLOYED BY DAIMLER TRUCKS NORTH AMERICA, THE SPONSOR OF THE BENEFIT PLAN AND TRUST. KELLEY PLATT IS RELATED TO ALL OTHER MEMBERS OF THE INVESTMENT COMMITTEE THROUGH A BUSINESS RELATIONSHIP. ALL INVESTMENT COMMITTEE MEMBERS ARE EMPLOYED BY DAIMLER TRUCKS NORTH AMERICA, THE SPONSOR OF THE BENEFIT PLAN AND TRUST. BOB ROBERTSON IS RELATED TO ALL OTHER MEMBERS OF THE INVESTMENT COMMITTEE THROUGH A BUSINESS RELATIONSHIP. ALL INVESTMENT COMMITTEE MEMBERS ARE EMPLOYED BY DAIMLER TRUCKS NORTH AMERICA, THE SPONSOR OF THE BENEFIT PLAN AND TRUST. DAVID SWAINSON IS RELATED TO ALL OTHER MEMBERS OF THE INVESTMENT COMMITTEE THROUGH A BUSINESS RELATIONSHIP. ALL INVESTMENT COMMITTEE MEMBERS ARE EMPLOYED BY DAIMLER TRUCKS NORTH AMERICA, THE SPONSOR OF THE BENEFIT PLAN AND TRUST. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE CORPORATE TAX DIRECTOR AND THE PLAN ADMINISTRATOR PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION RELIES ON THE SARBANES-OXLEY ACT, INTERNAL CONTROLS, AND OUTSIDE AUDITS TO ENSURE THAT THE CONFLICT OF INTEREST POLICY IS ENFORCED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT COMPENSATE INTERESTED PERSONS. THEREFORE, THE ORGANIZATION DOES NOT HAVE A PROCESS IN PLACE FOR DETERMINING AND REVIEWING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE MADE AVAILABLE TO PARTICIPANTS UPON REQUEST. DTNA EMPLOYEE BENEFIT BASIC TRUST 2701 NW VAUGHN STSUITE 900 PORTLAND OR 97210 943067499 VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. OR 501 (C) (9) DAIMLER TRUCKS NORTH AMERICA 0 DTNA EMPLOYEE BENEFIT SUPPLEMENTAL TRUST 2701 NW VAUGHN STSUITE 900 PORTLAND OR 97210 930886584 VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. OR 501 (C) (9) DAIMLER TRUCKS NORTH AMERICA 0 DTNA UNION EMPLOYEE BENEFIT BASIC TRUST 2701 NW VAUGHN STSUITE 900 PORTLAND OR 97210 931092580 VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. OR 501 (C) (9) DAIMLER TRUCKS NORTH AMERICA 0 DTNA UNION EMPLOYEE BENEFIT SUPPLEMENTAL TRUST 2701 NW VAUGHN STSUITE 900 PORTLAND OR 97210 931092582 VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. OR 501 (C) (9) DAIMLER TRUCKS NORTH AMERICA 0 DTNA EMPLOYEE BENEFIT SUPPLEMENTAL TRUST 2 2701 NW VAUGHN STSUITE 900 PORTLAND OR 97210 931098095 VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. OR 501 (C) (9) DAIMLER TRUCKS NORTH AMERICA 0 MT HOLLY SHOP UAW RETIREE MEDICAL PREMIUM TRUST 2701 NW VAUGHN STSUITE 900 PORTLAND OR 97210 931207918 VEBA TRUST FOR THE PAYMENT OF BENEFITS FOR MEMBERS. OR 501 (C) (9) DAIMLER TRUCKS NORTH AMERICA 0 DAIMLER TRUCKS NORTH AMERICA LLC 2701 NW VAUGHN ST SUITE 900 PORTLAND OR 97210 930790608 VEHICLE MANUFACTURER OR N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 DAIMLER TRUCKS NORTH AMERICA LLC S 9364024 EMPLOYER CONTRIBUTIONS - FMV