2013-11-15T13:22:24-06:00 2012-12-31 990 2012-01-01 226058341 TEAMSTERS INDUSTRIAL EMPLOYEES WELFARE FUND TEAM 2018673553 707 SUMMIT AVENUE UNION CITY NJ 07087 ROBERT BLUMENFELD 2018671477 2013-11-15 2012 2016-02-25 16:41:14Z ROBERT BLUMENFELD 707 SUMMIT AVENUE UNION CITY NJ 07087 17195208 0 X WWW.560BENEFITFUNDS.COM X 1948 NJ TO PROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. 4 3 0 0 0 0 0 0 12204525 13471365 486173 423965 140943 98142 12831641 13993472 0 0 13576361 16030992 2881 1886 0 0 0 810136 822591 14389378 16855469 -1557737 -2861997 11037914 8877467 2221169 2667753 8816745 6209714 TO PROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 TO PROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 1 0 1 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 1 223 0 1 0 0 0 0 0 0 0 X 4 3 1 0 0 0 1 0 0 1 0 0 0 1 1 1 1 0 1 0 0 0 X ROBERT BLUMENFELD 2018671447 707 SUMMIT AVENUE UNION CITY NJ 07087 EDWIN H STIER 1.00 X 1886 1886 0 ANTHONY VALDNER 2.00 X 0 0 0 CHARLES T CONNORS 1.00 X 0 0 0 CHARLES D'ANGELO 1.00 X 0 0 0 LOUIS RODRIGUEZ 1.00 X 0 0 0 JEFFREY BRUNNER 1.00 X 0 0 0 ROBERT BLUMENFELD 10.00 X 0 0 0 1886 1886 0 0 0 0 0 HORIZON BLUE CROSS BLUE SHIELD PO BOX 15306 NEWARK NJ 07105 HEALTH CARE PROVIDER 355894 TC3 HEALTH INC 19732 MACARTHUR BLVD SUITE 100 IRVINE CA 92612 CLAIMS REPRICING AGENT 127443 2 EMPLOYER CONTRIBUTIONS 525100 13391840 13391840 COBRA 525100 79525 79525 13471365 105701 105701 3520000 3201736 318264 318264 318264 PRESCRIPTION REBATE INCOME 525100 92857 92857 OTHER INCOME 525100 5285 5285 98142 13993472 13569507 0 423965 16030992 1886 50819 22700 40496 63767 71606 50461 40329 514 6827 10528 ALLOCATED SALARIES AND 463786 DUES AND SUBSCRIPTIONS 758 16855469 198984 405575 1358052 1480934 7157 8614 54683 38041 22656 16642 9183428 6456779 267637 508923 11037914 8877467 166377 66543 2054792 2601210 2221169 2667753 X 0 0 0 0 8816745 6209714 8816745 6209714 11037914 8877467 -2861997 254966 0 X X 0 1 X 1 0 4019 4019 0 49894 33252 16642 770 770 0 16642 COMMON COLLECTIVE TRUSTS 5092131 F LIMITED PARTNERSHIPS 1364648 F 6456779 HORIZON ADVANCE DEPOSIT 230617 PRESCRIPTION REBATE RECEIVABLE 35653 DUE FROM BROKER FOR PENDING SALE 220000 DIVIDEND RECEIVABLE 6018 OTHER RECEIVABLE 16635 508923 CLAIMS PAYABLE AND CLAIMS INCURRED BUT NOT REPORTED 2427800 OTHER LIABILITIES 51363 DUE TO AFFILIATES, NET 1029 DUE TO BROKER FOR SECURITIES PURCHASED 121018 2601210 X 14207942 254966 254966 13952976 40496 40496 13993472 16385873 -429100 -429100 16814973 40496 40496 16855469 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITION TAKEN BY THE PLAN, AND HAS CALULATED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGES IN BENEFIT OBLIGATION -429,100. FORM 990, PART VI, SECTION A, LINE 2 JEFFREY BRUNNER, FORMER EMPLOYER TRUSTEE, DIVISION PRESIDENT INERGY PROPANE, LLC HAD A BUSINESS RELATIONSHIP WITH CHARLES T. CONNORS, PRESIDENT OF H&M INTERNATIONAL COMPANY. FORM 990, PART VI, SECTION A, LINE 6 THE PLAN HAS PARTICIPANTS. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD DURING 2012. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION PREPARES THE FORM 990. THE INDEPENDENT AUDITOR REVIEWS THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE TRUSTEES OF THE ORGANIZATION BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE PLAN IS BOUND BY ERISA PROHIBITED TRANSACTION RULES WHICH PRECLUDE THE PLAN FROM ENGAGING IN ANY NON-EXEMPT PARTY IN INTEREST TRANSACTIONS. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS ARE PROVIDED TO PARTICIPANTS AND OTHER INTERESTED PARTIES UPON REQUEST. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. 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