2018-11-15T18:33:38-06:00 2017-12-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2017-01-01 530209136 JOINT BOARD OF TRUSTEES OF THE LOCAL 639 EMPLOYERS HEALTH TRUST FUND PLAN TEAM 4108729500 3130 AMES PLACE NE WASHINGTON DC 20018 THOMAS RATLIFF TRUSTEE 4108729500 2018-11-15 1 SCOTT E HALLBERG CPA P01081188 2023319880 38.100.43.98 2018-11-15 19:33:25 ES P 31A954A32AED5168E1D2D9711EACA06BFDB1B55C 9C9577FFC368BC1A918C54DC8B2D99B90FEEC978 2017 2019-02-21 02:37:17Z THOMAS RATLIFF 3130 AMES PLACE NE WASHINGTON DC 20018 99637624 0 X N/A X 1952 DC TO PROVIDE HEALTH & WELFARE INSURANCE BENEFITS TO EMPLOYEES (AND THEIRELIGIBLE DEPENDENTS) OF CONTRIBUTING EMPLOYERS WHO ARE REPRESENTED BYTHE PARTICIPATING LOCAL UNION 8 0 0 0 0 0 0 0 47099737 46596265 2744565 5137806 419 55352 49844721 51789423 0 0 30394722 37299800 29474 52423 0 0 0 4358798 4031919 34782994 41384142 15061727 10405281 162576438 178893625 1062083 1098514 161514355 177795111 TO PROVIDE COVERAGE FOR HOSPITALIZATION, MEDICAL BENEFITS, MENTAL HEALTH BENEFITS, DISABILITY INCOME, DEATH BENEFITS, PRESCRIPTION DRUGS, DISEASE CASE MANAGEMENT, DENTAL, AND VISION CARE BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 0 0 PAYMENT OF MEDICAL AND OTHER BENEFITS TO OR FOR ITS PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 15 0 1 0 0 0 0 0 0 0 0 0 X 8 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 1 0 0 0 X CARDAY ASSOCIATES 4108739020 7310 COLUMBIA GATEWAY DRIVE SUITE A COLUMBIA MD 21046 ERIC D WEISS CHAIRMAN-EMPLOYER 2.00 2.00 X 12745 0 0 MICHAEL BULL TRUSTEE-EMPLOYER 2.00 X 13637 0 0 THOMAS RATLIFF SECRETARY-UNION 2.00 40.00 X 0 138269 44035 FRANK W STEGMAN TRUSTEE-EMPLOYER 2.00 2.00 X 0 0 0 J ANTHONY SMITH TRUSTEE-UNION 2.00 40.00 X 0 121464 44035 JOHN GIBSON TRUSTEE-UNION 2.00 40.00 X 0 129145 44035 PHILIP GILES TRUSTEE-UNION 2.00 X 13431 0 0 RAYMOND HOWARD TRUSTEE-EMPLOYER 2.00 X 11753 0 0 51566 388878 132105 0 0 1 0 CVS CAREMARK INC ONE CVS DRIVE WOONSOCKET RI 02895 PRESCRIPTION BENEFIT MANAGEMENT 6476280 DENTAL HEALTH CENTERS & ASSOCIATES 1450 MERCANTILE LN 131 UPPER MARLBORO MD 20774 DENTAL CLINIC 2319372 CIGNA HEALTHCARE 900 COTTAGE GROVE ROAD BLOOMFIELD CT 06002 CLAIMS PROCESSING 1161744 CARDAY ASSOCIATES 7130 COLUMBIA GATEWAY DR A COLUMBIA MD 21046 THIRD PARTY ADMINISTRATOR 927686 MORGAN LEWIS & BROCKIUS 1111 PENNSYLVANIA AVENUE WASHINGTON DC 20004 LAW FIRM 293074 7 CONTRIBUTIONS-EMPLOYERS 525100 46444701 46444701 CONTRIBUTIONS-PARTICIPANTS 525100 151564 151564 46596265 4435715 4435715 48550292 47848201 702091 702091 702091 SECURITY LITIGATION PROCEEDS 525100 55352 55352 55352 51789423 46596265 0 5193158 37299800 52423 895230 515246 48538 742916 165460 77219 6439 48148 NETWORK PPO FEES 1171518 TRANSITIONAL REINSURANC 180252 OONP EXPENSES 115189 BANK FEES 50534 15230 41384142 -1822412 6354565 20577388 18708169 5642571 5500827 89010134 99115025 47074026 47888732 2094731 1326307 162576438 178893625 763732 729554 298351 368960 1062083 1098514 X 161514355 177795111 0 0 0 0 161514355 177795111 162576438 178893625 10405281 5875475 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 23700152 F HEDGE FUNDS 660694 F REAL ESTATE 23527886 F 47888732 DUE TO BROKER 368960 368960 X 56921982 5875475 5875475 51046507 742916 742916 51789423 40641226 0 40641226 742916 742916 41384142 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 ORGANIZATION HAS TAKEN AS UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION. THE PLAN ADMINISTRATOR IS NOT AWARE OF ANY UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2017. THE PLAN IS SUBJECT TO ROUTINE AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2014. PART XII, LINE 4B - OTHER ADJUSTMENTS INVESTMENT EXPENSES 742,916 0 0 0 THOMAS RATLIFF SECRETARY-UNION 0 138269 0 0 0 0 0 30037 0 13998 0 182304 0 0 J ANTHONY SMITH TRUSTEE-UNION 0 121464 0 0 0 0 0 30037 0 13998 0 165499 0 0 JOHN GIBSON TRUSTEE-UNION 0 129145 0 0 0 0 0 30037 0 13998 0 173180 0 0 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 HAS BEEN PROVIDED TO THE FUND'S ADMINISTRATOR TO BE DISTRIBUTED TO THE FUND'S BOARD OF TRUSTESS PRIOR TO ITS FILING FORM 990, PART VI, SECTION B, LINE 12C THE FUND IS SUBJECT TO THE REQUIREMENTS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT, AS AMENDED 1974 ("ERISA"), INCLUDING THE STATUTE'S FIDUCIARY STANDARDS AND PROHIBITED TRANSACTION PROVISIONS, WHICH TOGETHER CONSTITUTE THE FUND'S CONFLICT OF INTEREST POLICY. THE BOARD OF TRUSTEES, ALONG WITH THE VARIOUS FUND PROFESSIONALS' ASSISTANCE, MONITOR AND ENFORCE THE FUND'S COMPLIANCE WITH ERISA AND ALSO THE INTERNAL REVENUE CODE. FORM 990, PART VI, SECTION C, LINE 19 THE FUND'S ANNUAL FINANCIAL DISCLOSURE STATEMENT, THE FORM 5500, IS AVAILABLE FOR PUBLIC INSPECTION THROUGH CERTAIN WEBSITES, INCLUDING BUT NOT LIMITED TO, THE UNITED STATES DEPARTMENT OF LABOR'S FORM 5500 FILING SEARCH AND FREEERISA. THE FUND MAKES ITS GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS, BENEFICIARIES, THE SPONSORING UNION, AND CONTRIBUTING EMPLOYERS AS REQUIRED BY ERISA. ERISA DOES NOT REQUIRE THE FUND TO MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC AND THE FUND DOES NOT DO SO. FORM 990, PART XII, LINE 2C: THE TRUSTEES EVALUATE AND APPROVE THE INDEPENDENT AUDITOR. TEAMSTERS LOCAL 639 EMPLOYERS PENSION TRUST FUND 3130 AMES PLACE NE WASHINGTON DC 20018 PENSION FUND MD 401(A) 0 TEAMSTERS LOCAL 639 LEGAL SERVICES FUND 3130 AMES PLACE NE WASHINGTON DC 20018 LEGAL FUND MD 501(C)(9) 0 TEAMSTERS LOCAL UNION 639 3130 AMES PLACE NE WASHINGTON DC 20018 LABOR UNION MD 501(C)(5) 0 ABF FREIGHT ADVANTAGE CONF & EXPO ALLIANCE EXPOSITION SERVICES ALUMA SYSTEMS CONCRETE ARATA EXPOSITIONS BOILER & FURNACE BREDE WASHINGTON CLARK CONSTRUCTION COLLINGTON SERVICE ALBERT M BRIGS COMPANY CRANE RENTAL DRIVERS CHAUFFEURS APCOM POWER EL GARDNER EXPO LABOR PROS FREEMAN DECORATING GALLIHER & HUGUELY GES EXPOSITION SERVICE GIANT FOOD HUNGRY MAN PRODUCTIONS HARGROVE INC HERITAGE EXPO HUTCHINSON INTERNATIONAL JJ TAYLOR LAMAR & WALLACE LBM MARTIN-BROWER MARVA MAID MDVA MILK PRODUCERS MERIT CONCRETE METRO MECHANICAL METROPOLITAN POULTRY MONDELEZ INTERNATIONAL NEXXTSHOW NOLAND OTTENBERG'S BAKER NATIONAL EXPO PIERCE ASSOCIATES POTOMAC DISPOSAL SERVICE S FREEDMAN & SONS REPUBLIC NATIONAL DISTRIBUTING CO SAFEWAY STORES SECURITY STORAGE SHENANDOAH'S PRIDE SHEPARD EXPOSITION SILVER HILL MATERIAL SILBER HILL AGGREGATES LTD STROMBERG SUPER CONCRETE TRAX INTERNATIONAL 21ST CENTURY TWP ENTERPRISES TRAVEL COURTS INC UPS WASHINGTON WHOLESALE YRC WORLDWIDE JOINT BOARD OF TRUSTEES LOCAL 639 EMPLOYERS HEALTH 3130 AMES PL NE WASHINGTON DC 20018 530209136 PLAN SPONSOR MD 0 ZENITH AMERICAN SOLUTIONS SHENANDOAH FLEET MAINTENANCE PARAMOUNT CONVENTION SERVICES INC BOURNE 5 PRODUCTIONS BOARD DAYLIGHT LLC EMPLOYCO SERVICES LTD WUW-SACHA KIEWIT ENERGY COMPANY RUAN LOGISTICS CORPORATION SNC-LAVALIN CONSTRUCTION INC TEXAS EXPOSITION SERVICES UNIVERSAL TELEVISION 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1