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TEAMSTER BENEFIT TRUST: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
TEAMSTER BENEFIT TRUST (EIN 94-2848389)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-08-09
IRS object ID
201332219349301613
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-09T19:36:06-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN522385296EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LINDQUIST LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15000 EXECUTIVE PARKWAY SUITE 400AddressLine1
CitySAN RAMONCity
StateCAState
ZIP Code945834346ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN942848389EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1TEAMSTERS BENEFIT TRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlTEAMNameControl
Phone5107964676Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1POST OFFICE BOX 5820AddressLine1
CityFREMONTCity
StateCAState
ZIP Code94537ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROME ALOISEName
TitleTRUSTEETitle
Phone5107964676Phone
Date Signed2013-08-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJESSICA R ROSTERName
PTINP01317380PTIN
Phone9252779100Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonROME ALOISENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1POST OFFICE BOX 5820AddressLine1
CityFREMONTCity
StateCAState
ZIP Code94537ZIPCode
FieldValueIRS element (for citing)
Gross Receipts254437080GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.TEAMSTERSBENEFITTRUST.COMWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1982YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH AND WELFARE BENEFITS.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees7TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year235212673ProgramServiceRevenuePriorYear
Program Service Revenue CY245330228ProgramServiceRevenueCY
Investment Income Prior Year5555262InvestmentIncomePriorYear
Investment Income Current Year4203473InvestmentIncomeCurrentYear
Other Revenue Prior Year48991OtherRevenuePriorYear
Other Revenue Current Year143920OtherRevenueCurrentYear
Total Revenue Prior Year240816926TotalRevenuePriorYear
Total Revenue Current Year249677621TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year225829585BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY233901059BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8737500OtherExpensePriorYear
Other Expenses Current Year8834782OtherExpensesCurrentYear
Total Expenses Prior Year234567085TotalExpensesPriorYear
Total Expenses Current Year242735841TotalExpensesCurrentYear
Revenues Less Expenses Prior Year6249841RevenuesLessExpensesPriorYear
Revenues Less Expenses CY6941780RevenuesLessExpensesCY
Total Assets BOY151652583TotalAssetsBOY
Total Assets EOY168532474TotalAssetsEOY
Total Liabilities BOY34764688TotalLiabilitiesBOY
Total Liabilities EOY32034983TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY116887895NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY136497491NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionPROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10961992NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees7NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LIPMAN INSURANCE ADMINISTRATORBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5107964676TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line139420 LIBERTY ST SUITE 260AddressLine1
CityFREMONTCity
StateCAState
ZIP Code94538ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
WILLIAM ALBANESE
TRUSTEE1.00X000
KEITH FLEMING
TRUSTEE5.00X000
RICHARD JORDAN
TRUSTEE1.00X000
JEANETTE PAIGE
TRUSTEE1.00X000
RICHARD MURPHY
TRUSTEE1.00X000
BILL ROSSI
TRUSTEE1.00X000
ROME ALOISE
TRUSTEE5.00X000
CARLOS BORBA
TRUSTEE1.00X000
ROBERT MORALES
TRUSTEE1.00X000
BILL HOYT
TRUSTEE1.00X000
RON PAREDES
TRUSTEE1.00X000
DALE ROBBINS
TRUSTEE1.00X000
CHRIS SERVI
TRUSTEE1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
LIPMAN INSURANCE ADMINISTRATORS INC
39420 LIBERTY STREET SUITE 260FREMONTCA94538ADMINISTRATOR5711535
BLUE CROSS
21555 OXNARD STREET AC-1JWOODLAND HILLSCA91367COST CONTAINMENT649337
CAREALLIES
5144 COLLECTION CENTER DRIVECHICAGOIL60693COST CONTAINMENT486385
LINDQUIST LLP
5000 EXECUTIVE PARKWAY SUITE 400SAN RAMONCA94583AUDIT SERVICES423924
TEAMSTERS ASSISTANCE PROGRAM
300 PENDLETON WAYOAKLANDCA946212109EMPLOYEE ASSISTANCE SERVICES261442
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS900099227175489227175489
PARTICIPANT CONTRIBUTI9000991591295515912955
MEDICARE PART D SUBSID90009910145051014505
STOP LOSS REFUNDS900099999777999777
LIQUIDATED DAMAGES900099171580171580

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column55922TotalRevenueColumn
Related Or Exempt Function Income55922RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue245330228TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3348105TotalRevenueColumn
Exclusion$3,348,105ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5614827Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4759459Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities855368Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column855368TotalRevenueColumn
Exclusion$855,368ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column143920TotalRevenueColumn
Exclusion$143,920ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue143920TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column249677621TotalRevenueColumn
Related Or Exempt Function Income245330228RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$4,347,393ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total233901059Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total5709945Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total222704Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total340288Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total251930Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2087662Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total103487Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total33170Total

Insurance Insurance

FieldValueIRS element (for citing)
Total67710Total

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS EXPENSEDescription
Total17886Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total242735841Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-926613BOY
EOY-852222EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY7174015BOY
EOY9050298EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY20401886BOY
EOY20557060EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY847094BOY
EOY844163EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY118086691BOY
EOY132341623EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY5608310BOY
EOY6130352EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY461200BOY
EOY461200EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY151652583BOY
EOY168532474EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY13285008BOY
EOY13071643EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY562280BOY
EOY471940EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY20917400BOY
EOY18491400EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY34764688BOY
EOY32034983EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY116887895BOY
EOY136497491EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY116887895BOY
EOY136497491EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY151652583BOY
EOY168532474EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses6941780ReconcilationRevenueExpenses
Reconcilation Other Changes12667816ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ACCUMULATED ELIGIBILITY CREDITS$18,383,400
DEATH BENEFIT OBLIGATIONS$108,000
FieldValueIRS element (for citing)
Total Of Amounts18491400TotalOfAmounts
Total Revenue249677621TotalRevenue
Total Expenses242735841TotalExpenses
Excess Or Deficit For Year6941780ExcessOrDeficitForYear
Net Unrealized GL On Investments12667816NetUnrealizedGLOnInvestments
Other-$2,658,888OtherAmount
Total Adjustments10008928TotalAdjustments
Excess Or Deficit Per FS16950708ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt262093507TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments12667816NetUnrealizedGainsInvestments
Revenue Not Rptd F99012667816RevenueNotRptdF990
Revenue Subtotal249425691RevenueSubtotal
Investment Expenses Not Included251930InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt251930RevenueNotRptdOnFinStmt
Total Revenue Per Form990249677621TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt245142799TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal245142799ExpensesSubtotal
Investment Expenses Not Included2251930InvestmentExpensesNotIncluded2
Other Expenses Not Included-2658888OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt-2406958ExpensesNotRptdOnFinStmt
Total Expenses Per Form990242735841TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF SEPTEMBER 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'S ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO THE FISCAL YEAR ENDING SEPTEMBER 30, 2009.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN BENEFIT OBLIGATIONS
PART XIII, LINE 4B - OTHER ADJUSTMENTS:CHANGE IN BENEFIT OBLIGATIONS

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART V, LINE 2ATHE 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 3THE TRUST HAS CONTRACTED WITH LIPMAN INSURANCE ADMINISTRATORS TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 11A 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 12CAT LEAST ONCE A YEAR, TRUSTEES AND OTHER FIDUCIARIES 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 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 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 12,667,816.CHANGES IN NET ASSETS OR FUND BALANCES:
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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SEE EXPLANATION AT PART VIIBusinessNameLine1
FieldValueIRS element (for citing)
Primary ActivitiesVARIOUSPrimaryActivities
Legal Domicile StateCALegalDomicileState
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS:ReturnReference
ExplanationTHE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF SEPTEMBER 30, 2012, THERE ARE APPROXIMATELY 338 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. 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 AND SPONSORING ORGANIZATION, IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS AND SPONSORING ORGANIZATIONS HAVE NOT BEEN INCLUDED ON SCHEDULE R.Explanation