2013-08-09T19:36:06-05:00 2012-09-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834346 990 2011-10-01 942848389 TEAMSTERS BENEFIT TRUST TEAM 5107964676 POST OFFICE BOX 5820 FREMONT CA 94537 ROME ALOISE 5107964676 2013-08-09 1 JESSICA R ROSTER P01317380 9252779100 2011 2016-02-24 21:20:13Z ROME ALOISE POST OFFICE BOX 5820 FREMONT CA 94537 254437080 0 X WWW.TEAMSTERSBENEFITTRUST.COM X 1982 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 13 0 7 0 0 0 0 0 235212673 245330228 5555262 4203473 48991 143920 240816926 249677621 0 0 225829585 233901059 0 0 0 0 0 8737500 8834782 234567085 242735841 6249841 6941780 151652583 168532474 34764688 32034983 116887895 136497491 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 0 1 X 1992 0 1 7 1 0 0 0 0 0 0 X 13 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 0 0 0 0 0 0 0 LIPMAN INSURANCE ADMINISTRATORS INC 39420 LIBERTY STREET SUITE 260 FREMONT CA 94538 ADMINISTRATOR 5711535 BLUE CROSS 21555 OXNARD STREET AC-1J WOODLAND HILLS CA 91367 COST CONTAINMENT 649337 CAREALLIES 5144 COLLECTION CENTER DRIVE CHICAGO IL 60693 COST CONTAINMENT 486385 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 AUDIT SERVICES 423924 TEAMSTERS ASSISTANCE PROGRAM 300 PENDLETON WAY OAKLAND CA 946212109 EMPLOYEE ASSISTANCE SERVICES 261442 10 EMPLOYER CONTRIBUTIONS 900099 227175489 227175489 PARTICIPANT CONTRIBUTI 900099 15912955 15912955 MEDICARE PART D SUBSID 900099 1014505 1014505 STOP LOSS REFUNDS 900099 999777 999777 LIQUIDATED DAMAGES 900099 171580 171580 55922 55922 245330228 3348105 3348105 5614827 4759459 855368 855368 855368 OTHER INCOME 900099 143920 143920 143920 249677621 245330228 0 4347393 233901059 5709945 222704 340288 251930 2087662 103487 33170 67710 MISCELLANEOUS EXPENSE 17886 242735841 -926613 -852222 7174015 9050298 20401886 20557060 847094 844163 118086691 132341623 5608310 6130352 461200 461200 151652583 168532474 13285008 13071643 562280 471940 20917400 18491400 34764688 32034983 X 0 0 0 0 116887895 136497491 116887895 136497491 151652583 168532474 X 6941780 12667816 X X 0 1 1 X 0 0 ACCUMULATED ELIGIBILITY CREDITS 18383400 DEATH BENEFIT OBLIGATIONS 108000 18491400 249677621 242735841 6941780 12667816 -2658888 10008928 16950708 262093507 12667816 12667816 249425691 251930 251930 249677621 245142799 0 245142799 251930 -2658888 -2406958 242735841 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 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 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 12,667,816. 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 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, 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.