2014-08-13T16:15:27-05:00 2013-09-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2012-10-01 942848389 TEAMSTERS BENEFIT TRUST TEAM 5107964676 POST OFFICE BOX 5820 FREMONT CA 94537 ROME ALOISE 5107964676 2014-08-13 1 JESSICA R ROSTER P01317380 9252779100 2012 2015-11-30 17:44:51Z ROME ALOISE POST OFFICE BOX 5820 FREMONT CA 94537 295643405 0 X WWW.TEAMSTERSBENEFITTRUST.COM X 1982 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 14 0 7 0 0 0 0 0 245330228 262920598 4203473 5629729 143920 10168 249677621 268560495 0 0 233901059 236706254 0 0 0 0 0 8834782 8870111 242735841 245576365 6941780 22984130 168532474 197112848 32034983 33891699 136497491 163221149 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 0 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 X 2047 0 1 7 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 ADMINISTRATOR 5107964676 39420 LIBERTY ST SUITE 260 FREMONT CA 94538 X WILLIAM ALBANESE 1.00 X 0 0 0 KEITH FLEMING 5.00 X 0 0 0 RICHARD JORDAN 1.00 X 0 0 0 JEANETTE PAIGE 1.00 X 0 0 0 RICHARD MURPHY 1.00 X 0 0 0 BILL ROSSI 1.00 X 0 0 0 ROME ALOISE 5.00 X 0 0 0 CARLOS BORBA 1.00 X 0 0 0 ROBERT MORALES 1.00 X 0 0 0 BILL HOYT 1.00 X 0 0 0 RON PAREDES 1.00 X 0 0 0 DALE ROBBINS 1.00 X 0 0 0 CHRIS SERVI 1.00 X 0 0 0 SAM ROSAS 1.00 X 0 0 0 0 0 0 0 0 0 0 LIPMAN INSURANCE ADMINISTRATORS INC 39420 LIBERTY STREET SUITE 260 FREMONT CA 94538 ADMINISTRATOR 5727118 BLUE CROSS 21555 OXNARD STREET AC-1J WOODLAND HILLS CA 91367 COST CONTAINMENT 631495 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDIT SERVICES 296706 TEAMSTERS ASSISTANCE PROGRAM 300 PENDLETON WAY OAKLAND CA 946212109 EMPLOYEE ASSISTANCE SERVICES 252147 BEESON TAYER & BODINE ROSS HOUSE 483 NINTH ST 2ND FLOOR OAKLAND CA 94607 LEGAL SERVICES 215739 11 EMPLOYER CONTRIBUTIONS 900099 244758583 244758583 PARTICIPANT CONTRIBUTIONS 900099 14610187 14610187 EXPERIENCE RATED REFUNDS 900099 2349913 2349913 MEDICARE PART D SUBSIDY 900099 852674 852674 STOP LOSS REFUNDS 900099 188324 188324 160917 160917 262920598 4159494 4159494 28553145 27082910 1470235 1470235 1470235 OTHER INCOME 900099 10168 10168 10168 268560495 262920598 0 5639897 236706254 5823064 254887 320824 183092 1817565 335747 49436 70167 MISCELLANEOUS EXPENSE 15329 245576365 -852222 -356627 9050298 9558879 20557060 22239250 844163 945613 132341623 133000906 6130352 31263627 461200 461200 168532474 197112848 13071643 14258192 471940 197507 18491400 19436000 32034983 33891699 X 0 0 0 0 136497491 163221149 136497491 163221149 168532474 197112848 22984130 3739528 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 31263627 F 31263627 ACCUMULATED ELIGIBILITY CREDITS 19436000 19436000 X 272116931 3739528 3739528 268377403 183092 183092 268560495 243329802 0 243329802 183092 2063471 2246563 245576365 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013, 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 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 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. 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 ITS GOVERNING DOCUMENTS,CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. 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. 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 9/30/13 THERE ARE APPROXIMATELY 316 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, 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 - PLATFORM ALLIED WASTE/ DRIVERS ALLIED WASTE/ SANTA CLARA ALLIED WASTE/BFI-SJ-MCHNS ALPHA PRESS, INC ALSCO ALTA WESTSIDE BLDG MAT ANDREINI BROTHERS, INC. ANGELO UTILITIES ANGELO UTILITIES ANNUZZI'S CONCRETE SERV. ARAMARK UNIFORM SERV(508) ARATA EXPOSITIONS, INC ARB - LOCAL 431 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 BECHTEL CON(RUSSELL CITY) BERKELEY FARMS LO 315 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 C.F. ARCHIBALD PAVING, IN CAL VALLEY CONSTRUCTION CALEX ENGINEERING COMPANY CALFIFRNIA TRADE BINDERY CALIF DEPT OF CORRECTIONS CALIF LABOR FED, AFK-CIO CALIF TEAMSTERS PUB AFFRS CALIF WASTE SOL-DRIV/MEC CALIFORNIA GLASS COMPANY CAPS/SERIAL PICTURES INC. CARONE & COMPANY, INC CARPENTER RIGGING & SUPPL CAST & CREW / BROWN HILL CEMEX CENTRAL CONCRETE SUPPLY C CHALLENGE DAIRY PRODUCTS CHANNEL LUMBER CO CHAUFFEURS, TMSTRS & HELP CHUCK MACK AND ASSOCIATE CITY OF YAKIMA POLICE CLOSE BLDG MATERIALS, INC COCA COLA BOTTLING CO CONCEPT SERVICES LLC CONCORD DISPOSAL SERVICE CONSOLIDATED PRINTING, CO CONTRA COSTA BUILDING CT CONTRI CONSTRUCTION CURTIN THEATRICAL MOVING CZARNOWSKI EXHIBIT DALY CITY SCAVENGER CO, I DARLING INTERNATIONAL, IN DECON ENVIRONMENTAL SERV DHL WORLDWIDE DINWIDDIE CONSTRUCTION CO DRAGADOS/FLATIRON/JV DUMBARTON QUARRY ASSOCIAT EAGLE DISTRIBUTION EAGLE SYSTEMS EARLE M JORGENSEN CO EASE ENTRTNMNT/LSF PROD EAST BAY FORKLIFT EAST BAY RESTAURANT SUPPL EAST BAY SANITARY COMPANY ECONOMY LUMBER CO ECONOMY TRUCKING SERVICES EL CAMINO PAVING, INC. EMPLOYCO SERVICES, INC ENGEL & GRAY TRUCKING ENGINEERED CONCRETE PLACE EP PROD / BLINK & WINK EP PROD / BLINK & WINK EVENT PRODUCTIONS LO 70 FANFA, INC. FEATURES PROC/PICROW INC. FERMA CORPORATION FLOYD JOHNSTON CONST. CO. FORCE COM / BOXER FILMS FOSTER FARMS - HAYWARD FREEMAN DECORATING CO FREMONT UNIVERSAL TRANS FSI / BOXER FILMS G&C/APS JOINT ADVENTURE G. BORTOLOTTO & COMPANY GALLADE CHEMICAL, INC GALLO SALES COMPANY GARDEN CITY SAN-DRIV/MEC GES, INC GHILOTTI BROTHERS, INC GHILOTTI CONSTRUCTION CO GILLIG CORPORATION GILLIS & LANE, INC GLOBE - BAY AREA FORKLIFT GOLDEN GATE DISPOS & RECY GOODFELLOW TOP GRADE CONS GRADE-WAY CONSTRUCTION GRANITE CONSTRUCTION CO GRANITE ROCK / PAVEX GRANITE ROCK BERRYESSA287 GREEN FESTIVAL, INC 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 - SURV SPOUSES IEDA INFRA SOURCE - LOCAL 287 INTERSTATE GRADING & PAVI J & M, INC. J F C INTERNATIONAL, INC JARRETT, INC. JAY N ENTERPRISES JBS BAKESERVICE JERRY THOMPSON & SONS JOANN'S WATER TRUCK SERV KIEWIT INFRASTRUCTURE KIEWIT POWER CONSTRUCTRS KIRK XPEDX PACKAGING KNIFE RIVER CONSTRUCTION LAKESIDE SPECIALIZED TRAN LARSEN BROS, INC LAWSON DRAYAGE, INC LEONARD TRANSPORT, LLC LIPMAN INSURANCE ADMIN/BA LITHOGRAPH REPROD, INC LITHOTYPE COMPANY, INC LUND CONSTRUCTION M.F. MAHER, INC. MAGGIORA & GHILOTTI INC MARIN SANITARY SERVICE MATERIAL RECOVERY SYSTEMS MAXUM EXPO SERVICES MCGUIRE AND HESTER MERCER FRASER COMPANY MICHELS PIPELINE CONSTR MILLER BLADES MISSION LINEN SUPPLY-853 MONTEREY MECHANICAL CO. MONTGOMERY CONTRACTORS MOUNTAIN CASCADE INC. NABISCO, INC NAPA CO RECYCLING & WASTE NATIONAL CONVENTION SERV NATURIPE BERRY GROWERS NORTH STATE AGGREGATE, INC O C JONES & SONS, INC O'GRADY PAVING, INC. OPERATING ENGIN, INTERNAT OSBORNE LUMBER CO INC PACIFIC RACING ASSOCIATIO PALMISANO DELIVERY - MO PAR ELECTRICAL CONTRACTOR PATTERSON HEAVY HAUL PAYEES / BIG SUR PROD PDEI / DETOUR NETWORK PENINSULA CRANE & RIGGING PERFORMANCE EQUIPMENT PERFORMANCE MECHANICAL PERFORMANCE MECHANICAL PES / BISCUIT FILMWORKS PIAZZA CONSTRUCTION PINE CONE LUMBER PLEASANTON READY MIX POTERO HILLS LANDFILL PREMEDIA SYSTEMS, INC PYRAMID PAINTING QUALITY TERMINAL SERVICE R & M PAVING CONTRACTORS R E SERRANO, INC R L DODGE CONSULTING RANSOME COMPANY RECOLOGY HAY RD LANDFIL RECOLOGY OF S.M.-CLERICAL RECOLOGY OF THE COAST RECOLOGY VALLEJO RECOLOGY WASTE ZERO REED & GRAHAM (BOTM DUMP) REEVES & PENDERGAST CONST RELIANCE SHEET & STRIP CO RELIANCE STEEL & ALUMINUM RENAISSANCE MANAGEMENT RICH READY MIX CONCRETE RICHMOND SANITARY SERVICE RINKER MATERIALS CORP ROCKFORD CORPORATION ROCKTENN ROGERS TRUCKS & EQUIP (RS ROGERS TRUCKS & EQUIPMENT RYAN ENGINEERING, INC. S F REC & DISP HAZ WASTE SAFEWAY CORP, INC (RSP) 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 CLASRA CHAMBR OF COM SAVE MART SUPERMARKETS SCHAWK, INC SE PIPE LINE CONSTRUCTION SECURITY PAVING CO, INC SERVICE WEST - CONV/TRADE SF CHRONICLE-DRIVERS 921 SHAMROCK MATERIALS, INC. SHEEDY DRAYAGE CO SHELDON GAS SHEPARD EXPOSITION SERV SIERRA POINT LUMBER SIMSMETAL USA SKANSKA/SHIMMIC/HERZOG/JV SNELSON COMPANIES, INC SO SAN FRANCISCO SCAVENGE SO VALLEY DISP CLERICAL SOLANO RECYCLES SOUTH BAY REC-CLERICAL SOUTH CITY LUMBER & SUPPL SOUTHERN WINE & SPIRITS SOUTHLAND TUTOR PERINI JV SPECIALIZED WATER SERV SPECIALTY SLD WSTE/CLERIC STAGE CALL, INC STATE BUILD & CON TRADE STEVE P RADOS, INC STICH CONSTRUCTION STICH CONSTRUCTION, INC SUGAR CITY BUILDING MATER SUNSET SCAV CO CLER UNIT SYAR CONCRETE SYAR INDUSTRIES, INC SYAR INDUSTRIES, INC (RS& SYSCO SAN FRANCISCO, INC T & M WATER TRUCK SERVICE TACKETT'S WATER SERVICE TEAM / MOTHERSHIP MEDIA TEAM GHILOTTI INC. TEAM SAN JOSE TEAMSTERS ASSISTANCE PROG TEAMSTERS LO 2785 B/A'S TEAMSTERS LO 287 TEAMSTERS LO 315-B/A'S TEAMSTERS LO 350-CLERICAL TEAMSTERS LO 665 TEAMSTERS LO 853-B/A'S 78 TEAMSTERS LO 853-BA/OFFST TEAMSTERS LO 890-CLERICAL TEAMSTERS LO 912 TEAMSTERS LO 986 TEAMSTERS LOCAL 2010 TEAMSTERS LOCAL 760 TEAMSTERS TRAINING TRUST TEICHERT AGGREGATES LO150 TELFER OIL CO. (DRIVERS) TELFER OIL CO.(SHOP&SRV) TETRA TECH EC, INC. 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