2016-12-06T13:20:32-06:00 2016-01-31 470900880 CALIBRE CPA GROUP PLLC 19615 S LAGRANGE ROAD MOKENA IL 60448 990 2015-02-01 362153764 INTERNATIONAL BROTHERHOOD OF TEAMSTERS 710 HEALTH & WELFARE FUND INTE 7732542500 9000 W 187TH STREET MOKENA IL 60448 JOHN T COLI TRUSTEE 7732542500 2016-12-06 1 CHARLES DIGIOVANNI P00284901 7089957180 2015 2017-02-10 21:41:12Z 9000 W 187TH STREET MOKENA IL 60448 71113679 0 X N/A X 1950 IL TO PROVIDE HEALTH BENEFITS TO THE ELIGIBLE PARTICIPANTS AND DEPENDENTS OF INTERNATIONAL BROTHERHOOD OF TEAMSTERS 710 HEALTH & WELFARE FUND. 5 5 17 0 0 0 0 0 49537294 49359353 3453959 1463183 7730 11905 52998983 50834441 0 0 51379256 47415654 1033865 1670923 0 0 0 1311661 1044876 53724782 50131453 -725799 702988 89688233 88420231 11217281 11461374 78470952 76958857 TO PROVIDE HEALTH BENEFITS TO THE ELIGIBLE PARTICIPANTS AND DEPENDENTS OF INTERNATIONAL BROTHERHOOD OF TEAMSTERS 710 HEALTH & WELFARE FUND. 0 0 TO PROVIDE HEALTH, LIFE, TEMPORARY DISABILITY, ACCIDENTAL DEATH AND DISMEMBERMENT, PRESCRIPTION DRUGS, DENTAL AND VISION BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR 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 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 958 0 1 17 1 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 X BRIAN O'MALLEY 7732542500 9000 W 187TH STREET MOKENA IL 60448 JOHN T COLI CHAIRMAN/TRUSTEE 1.00 X 0 0 0 STEPHANIE K BRINSON TRUSTEE 1.00 X 0 0 0 PHILLIP D STANOCH FMR SECRETARY TREASURER/TRUSTEE 1.00 X 0 0 0 TOM J VENTURA FMR TRUSTEE 1.00 X 0 0 0 SAMUEL D PILGER SECRETARY TREASURER/TRUSTEE 1.00 X 0 0 0 GARY CALDWELL TRUSTEE 1.00 X 0 0 0 BERNARD T SHERLOCK TRUSTEE 1.00 45.00 X 0 170810 40336 BRIAN O'MALLEY ADMINISTRATOR 25.00 25.00 X 329988 0 41216 329988 170810 81552 1 0 1 0 BLUE CROSS BLUE SHIELD 300 E RANDOLPH CHICAGO IL 60601 BENEFIT CONTRACT ADMINISTRATOR 1315785 PAUL M NEWCOMER 2609 CROOKS ROAD SUITE 106 TROY MI 48084 LEGAL 130756 WILLIG WILLIAMS & DAVIDSON 1845 WALNUT ST 24TH FL PHILADELPHIA PA 19103 LEGAL 127031 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WE BETHESDA MD 19103 ACCOUNTING & AUDIT 103331 4 EMPLOYER CONTRIBUTIONS 900099 48381788 48381788 RETIREE CONTRIBUTIONS 900099 434000 434000 PARTICIPANT CONTRIBUTI 900099 381023 381023 CLAIMS REFUND 900099 162542 162542 49359353 1613137 1613137 20129284 20279238 -149954 -149954 -149954 MISCELLANEOUS INCOME 900099 11905 11905 11905 50834441 49371258 0 1463183 47415654 185702 473725 826971 142502 42023 268152 93645 96023 35193 154576 125228 170731 7709 6286 87333 50131453 727001 867486 3353543 4861805 5242093 5379565 728494 252539 409186 386983 20044 22203 76127928 73883080 3489130 3153553 89688233 88420231 181597 50596 11035684 11410778 11217281 11461374 X 0 0 0 0 78470952 76958857 78470952 76958857 89688233 88420231 702988 -2215083 0 X X 0 1 X 1 0 409186 386983 22203 22203 LIABILITY FOR LOSS ON SECURITIES LENDING 265250 LIABILITY TO RETURN CASH COLLATERAL HELD FOR SECURITIES ON LOAN 3153553 CLAIMS AND INS PREMIUMS PAYABLE 2092964 CLAIMS INCURRED BUT NOT REPORTED 5420422 PRESCRIPTION BENEFITS PAYABLE 325098 DENTAL FEES PAYABLE 5058 DUE TO RELATED FUND 20175 DUE TO BROKER 128258 11410778 X 48523335 -2215083 -2215083 50738418 96023 96023 50834441 49469517 0 49469517 96023 565913 661936 50131453 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEES BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN CLAIMS AND PREMIUMS PAYABLE 1,027,564. DECREASE IN CLAIMS INCURRED BUT NOT REPORTED -378,315. DECREASE IN PRESCRIPTION BENEFITS PAYABLE -85,659. INCREASE IN DENTAL FEES PAYABLE 2,323. 1 0 0 0 BERNARD T SHERLOCK TRUSTEE 0 170810 0 0 0 0 0 22932 0 17404 0 211146 0 0 BRIAN O'MALLEY ADMINISTRATOR 329988 0 0 0 0 0 11686 11686 8922 8922 350596 20608 0 0 MICHAEL O'MALLEY EMPLOYEE 123371 MICHAEL O'MALLEY IS AN EMPLOYEE OF THE PLAN. THE PLAN PAYS MICHAEL O'MALLEY A SALARY AND CONTRIBUTES TO EMPLOYEE BENEFIT PLANS ON HIS BEHALF. MICHAEL O'MALLEY IS A FAMILY MEMBER OF A CURRENT KEY EMPLOYEE OF THE PLAN. 0 ILLINOIS ADVOCATES LAW FIRM OWNED BY SON OF A TRUSTEE OF THE PLAN 44729 CO-COUNSEL WITH WILLIG, WILLIAMS AND DAVIDSON RECEIVES LEGAL FEES 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ADMINISTRATOR AND IS MADE AVAILABLE TO THE TRUSTEES PRIOR TO FILING. THE FORM IS SIGNED AND FILED AFTER THIS REVIEW. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE REVIEWED PERIODICALLY BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. IB OF T LOCAL NO 710 PENSION FUND 9000 W 187TH STREET MOKENA IL 60448 362377656 PROVIDE RETIREMENT, DISABILITY AND DEATH BENEFITS IL 501(A) N/A 0 EMPLOYEES PENSION PLAN OF IB OF T UNION LOCAL 710 H&W FUND 9000 W 187TH STREET MOKENA IL 60448 362153764 PROVIDE RETIREMENT, DISABILITY AND DEATH BENEFITS IL 501(A) N/A 0 IB OF T LOCAL UNION NO 710 9000 W 187TH STREET MOKENA IL 60448 361460890 CONTIRBUTING EMPLOYER IL 501(C)(5) N/A 0 AIRGAS INC CONTRIBUTING EMPLOYER 0 ANICHINI BROS INC CONTRIBUTING EMPLOYER 0 ARKANSAS BEST FRT-GE CONTRIBUTING EMPLOYER 0 AURORA PACKING CO D CONTRIBUTING EMPLOYER 0 BREAKTHRU BEVERAGE G CONTRIBUTING EMPLOYER 0 BROWN PACKING COMPAN CONTRIBUTING EMPLOYER 0 CAPITOL WHOLESALE ME CONTRIBUTING EMPLOYER 0 CASSENS TRANSPORT CO CONTRIBUTING EMPLOYER 0 CITY FOODS CONTRIBUTING EMPLOYER 0 CND TRANSPORTATION CONTRIBUTING EMPLOYER 0 CPC LOGISTICS INC CONTRIBUTING EMPLOYER 0 DAILY MEAT SUPPLY I CONTRIBUTING EMPLOYER 0 DARLING INTERNATIONA CONTRIBUTING EMPLOYER 0 FOUR STAR FOODS INC CONTRIBUTING EMPLOYER 0 GOLDEN STATE FOODS CONTRIBUTING EMPLOYER 0 GROVE MEAT COMPANY I CONTRIBUTING EMPLOYER 0 GUARINO WHOLESALE I CONTRIBUTING EMPLOYER 0 H & M INTERNATIONAL CONTRIBUTING EMPLOYER 0 HEBDING TRANSPORT I CONTRIBUTING EMPLOYER 0 HOFMEISTER JOHN AND CONTRIBUTING EMPLOYER 0 JACK COOPER TRANSPOR CONTRIBUTING EMPLOYER 0 KALUZNY BROTHERS IN CONTRIBUTING EMPLOYER 0 L AND L PROVISION CONTRIBUTING EMPLOYER 0 LINCOLN PROVISIONS I CONTRIBUTING EMPLOYER 0 MAHONEY ENVIRONMENTA CONTRIBUTING EMPLOYER 0 MONDELEZ GLOBAL LLC CONTRIBUTING EMPLOYER 0 MORREALE JOHN R I CONTRIBUTING EMPLOYER 0 NEALEY FOODS CONTRIBUTING EMPLOYER 0 PACIFIC RAIL SERVICE CONTRIBUTING EMPLOYER 0 RANDOLPH PACKING CO CONTRIBUTING EMPLOYER 0 ROSE PACKING COMPANY CONTRIBUTING EMPLOYER 0 RUWALDT PACKING COMP CONTRIBUTING EMPLOYER 0 SOUTHERN WINE & SPIR CONTRIBUTING EMPLOYER 0 STANDARD FORWARDING CONTRIBUTING EMPLOYER 0 STEINBACH PROVISION CONTRIBUTING EMPLOYER 0 STOCK YARDS CHICAGO CONTRIBUTING EMPLOYER 0 SYSCO CHICAGO INC CONTRIBUTING EMPLOYER 0 TOM TOM TAMALES COMP CONTRIBUTING EMPLOYER 0 USF HOLLAND INC CONTRIBUTING EMPLOYER 0 VANEK INC CONTRIBUTING EMPLOYER 0 WHITE CASTLE SYSTEM CONTRIBUTING EMPLOYER 0 WICHITA PACKING COMP CONTRIBUTING EMPLOYER 0 YRC WORLDWIDE CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1