2013-11-06T16:21:38-06:00 2012-12-31 208078757 SALTER & COMPANY LLC 4600 EAST-WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2012-01-01 530209136 TEAMSTERS LOCAL 639-EMPLOYERS HEALTH TRUST TEAM 2026368181 3130 AMES PLACE NE WASHINGTON DC 20018 THOMAS RATLIFF 2026368181 2013-11-06 1 JOSEPH M HERISHEN CPA P00361968 3018307400 2013-11-06 X 2012 2016-03-07 17:11:31Z THOMAS RATLIFF 3130 AMES PLACE NE WASHINGTON DC 20018 111053679 0 X N/A X 1952 DC TO PROVIDE HEALTH & WELFARE INSURANCE BENEFITS TO EMPLOYEES (AND THEIR ELIGIBLE DEPENDENTS) OF CONTRIBUTING EMPLOYERS WHO ARE REPRESENTED BY THE PARTICIPATING LOCAL UNION. 8 0 0 0 0 0 0 0 44519739 43274311 2718548 6118789 164774 7086 47403061 49400186 0 0 28789035 32734695 24000 24000 0 0 0 2996862 3320507 31809897 36079202 15593164 13320984 91011322 105525107 204519 317932 90806803 105207175 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 0 0 0 0 0 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 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 ZENITH AMERICAN SOLUTIONS 2026368181 3130 AMES PLACE NE WASHINGTON DC 20018 ERIC D WEISS 2.00 2.00 X 12000 19772 0 MICHAEL BULL 2.00 X 12000 0 0 THOMAS RATLIFF 2.00 40.00 X 0 119146 31460 FRANK W STEGMAN 2.00 4.00 X 0 19772 0 ANTHONY SMITH 2.00 40.00 X 0 102225 31460 JOHN GIBSON 2.00 40.00 X 0 110635 31460 PHILIP GILES 2.00 40.00 X 0 102125 31460 RAYMOND HOWARD 2.00 X 0 0 0 24000 473675 125840 0 0 1 0 0 CONTRIBUTIONS-EMPLOYER 900099 43100179 43100179 CONTRIBUTIONS-PARTICIPANTS 900099 174132 174132 43274311 2478273 2478273 65294009 61653493 3640516 3640516 3640516 SECURITY LITIGATION PROCEEDS 900099 6166 6166 DISTRIBUTION SETTLMENT 900099 920 920 7086 49400186 49400186 0 0 32734695 24000 968320 353559 84035 363259 122519 127641 12834 37636 NETWORK PPO FEES 1057432 MENTAL HEALTH ADMIN. FE 154287 BANK FEES 38985 36079202 -915095 -982202 14825526 8091204 5233675 5212338 70096879 93203767 1770337 0 91011322 105525107 204519 317932 204519 317932 X 90806803 105207175 0 0 0 0 90806803 105207175 91011322 105525107 13320984 1079388 0 X X 0 1 X 1 0 0 50128815 1079388 -350759 728629 49400186 0 49400186 35728443 0 35728443 350759 350759 36079202 PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSES -350,759. 0 0 0 THOMAS RATLIFF 0 119146 0 0 0 0 0 18564 0 12896 0 150606 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 HAS BEEN PROVIDED TO THE FUND'S ADMINISTRATOR TO BE DISTRIBUTED TO THE FUND'S BOARD OF TRUSTEES PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE FUND IS SUBJECT TO THE REQUIREMENTS OF THE EMPLOYEE RETIREMENT SECURITY ACT, AS AMENDED ("ERISA") AND THE FIDUCIARY STANDARDS OF ERISA, INCLUDING THE PROHIBITED TRANSACTION PROVISIONS, WHICH CONSTITUTE THE FUND'S CONFLICT OF INTEREST POLICY AND THE BOARD OF TRUSTEES MONITORS AND ENFORCES COMPLIANCE WITH THOSE PROVISIONS AS REQUIRED BY ERISA AND WITH THE ASSISTANCE OF THE FUND'S PROFESSIONALS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION ANNUAL FINANCIAL DISCLOSURE STATEMENTS FORM 5500 IS AVAILABLE FOR PUBLIC INSPECTION AT THE ERISA WEBSITE. 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. NO CHANGE HAS OCCURRED FROM THE PRIOR YEAR. 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