2013-10-08T11:15:21-05:00 2012-11-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2011-12-01 946072964 BAY AREA AUTOMOTIVE GROUP WELFARE FUND BAYA 5105287100 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 945687756 ERNIE YATES 5105287100 2013-10-08 1 DEBBIE R DIMERY P01065763 9252779100 2011 2016-02-24 21:20:13Z ERNIE YATES 4160 DUBLIN BOULEVARD NO 400 DUBLIN CA 945687756 37375158 0 X N/A X 1954 CA TO PROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND DEPENDENTS. 6 0 28 0 0 0 0 0 32289985 32193263 654536 403182 28414 745 32972935 32597190 0 0 32949258 34175155 34735 36382 0 0 0 1542675 1545017 34526668 35756554 -1553733 -3159364 19779977 16359178 5521808 5021884 14258169 11337294 TO PROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND DEPENDENTS. 0 0 PROVIDED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND DEPENDENTS 0 0 0 0 0 0 0 0 0 1 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 0 1 953 0 1 28 1 0 0 0 0 0 0 X 6 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X HEALTH SERVICES & BENEFIT ADMINISTR 9254497070 4160 DUBLIN BOULEVARD SUITE 400 DUBLIN CA 98568 X JOHN HORTON 1.00 X 0 0 0 LAWRENCE ROSE 1.00 X 0 0 0 MARK GLEASON 1.00 X 0 0 0 ERNIE YATES 1.00 X 0 0 0 CHUCK ANDREW 1.00 X 0 0 0 DAVID PANSINI 1.00 X 0 0 0 0 0 0 0 0 0 0 HEALTH SERVICES & BENEFIT ADMIN 4160 DUBLIN BOULEVARD SUITE 400 DUBLIN CA 945687756 ADMINISTRATOR FEE 881883 BLUE CROSS OF CALIFORNIA DEPARTMENT 5812 LOS ANGELES CA 900745812 PPO NETWORK FEE 129947 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 ACCOUNTING FEE 112124 BEESON TAYER & BODINE ROSS HOUSE SECOND FLOOR 483 NINTH OAKLAND CA 94607 LEGAL FEE 106469 4 EMPLOYER CONTRIBUTIONS 900099 29685794 29685794 STOP LOSS INCOME 900099 2005567 2005567 PARTICIPANT CONTRIBUTI 900099 501902 501902 32193263 328487 328487 4852663 4777968 74695 74695 74695 OTHER INCOME 900099 745 745 745 32597190 32194008 0 403182 34175155 36382 808254 153294 151553 33639 300095 65463 1291 31428 35756554 2394257 2732061 1006451 546490 3920683 3908767 23412 23000 12417838 9113768 17336 35092 19779977 16359178 1886808 2108884 3635000 2913000 5521808 5021884 X 0 0 0 0 14258169 11337294 14258169 11337294 19779977 16359178 X -3159364 238489 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 2913000 2913000 32597190 35756554 -3159364 238489 -502082 -263593 -3422957 32802040 238489 238489 32563551 33639 33639 32597190 36224997 0 36224997 33639 -502082 -468443 35756554 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT, AS OF NOVEMBER 30, 2012, 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 BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH HEALTH SERVICES & BENEFIT ADMINISTRATORS, INC., TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW. REVIEW OF THE FORM 990 WAS CONDUCTED BY THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C AT LEAST ONCE A YEAR, TRUSTEES AND OTHER INDIVIDUALS WHO ARE SUBJECT TO THE CONFLICT ON 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 PARTICIPATING IN ANY DECISION TO ENTER INTO ANY PROPOSED TRANSACTION OR ARRANGEMENT OR, IF LATER, AS SOON AS THE ACTUAL OR POTENTIAL CONFLICT IS RECOGNIZED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION AVAILABLE TO THE PARTICIPANTS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 238,489. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. TEAMSTERS AUTOMOTIVE & ALLIED WORKERS LOCAL UNION NO 665 1500 FRANKLIN STREET 3RD FLR SAN FRANCISCO CA 94109 LABOR UNION CA 501(C)(5) N/A N/A 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 NOVEMBER 30, 2012, THERE ARE APPROXIMATELY 120 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED TO BE REPORTED ON SCHEDULE R, SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT BEEN INCLUDED ON SCHEDULE R.