Form 5500 · Employee benefit plan · LOS ANGELES, CA
BOARD OF TRUSTEES TEAMSTERS MULTI-BENEFIT TRUST
The filing calls this plan TEAMSTERS MULTI-BENEFIT TRUST 1200 WILSHIRE BLVD 5TH FLOOR LOS ANGELES, CA 90017.
BOARD OF TRUSTEES TEAMSTERS MULTI-BENEFIT TRUST of LOS ANGELES, CA insures health, dental and vision coverage for its employees, per Schedule A of its Form 5500. Coverage is written through BLUE SHIELD OF CALIFORNIA and 9 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-6231741 · plan 501 · plan year 2024, filed Oct 10, 2025
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How this plan is funded
Fully insured as reported
The plan's own financial statement reports paying insurance carriers about what the insurance contracts report in premium.
Benefits declared on this filing
Dental: the largest of the 5 insured dental contracts, with SIMNSA, covers 67 of 1,966 participants (3.4%) on Schedule A.
Also declared: prepaid legal, death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 10 insured contracts covering health, dental and vision.
Reported premium is $11,817,129; the filing discloses no broker commission on these contracts.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
10 carriers appear on the filing, including BLUE SHIELD OF CALIFORNIA, UNITEDHEALTHCARE OF CALIFORNIA, KAISER FOUNDATION HEALTH PLAN, INC. and SIMNSA. BLUE SHIELD OF CALIFORNIA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE SHIELD OF CALIFORNIA | Health | 263 | Jan 1, 2025 | $5,102,383 | $0 |
| UNITEDHEALTHCARE OF CALIFORNIA | Health | 519 | Jan 1, 2025 | $4,282,791 | $0 |
| KAISER FOUNDATION HEALTH PLAN, INC. | Health | 0 | Jan 1, 2025 | $1,842,756 | $0 |
| SIMNSA | Health, Dental | 67 | Jan 1, 2025 | $199,948 | $0 |
| LIBERTY DENTAL PLAN OF CALIFORNIA, INC. | Health, Dental | 829 | Jan 1, 2025 | $156,916 | $0 |
| METROPOLITAN LIFE INSURANCE COMPANY (DAVIS VISION) | Vision | 1,201 | Jan 1, 2025 | $125,317 | $0 |
| DENTAL HEALTH SERVICES | Health, Dental | 185 | Jan 1, 2025 | $34,645 | $0 |
| UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. | Dental | 106 | Jan 1, 2025 | $34,625 | $0 |
| HMC HEALTHWORKS, INC. | Health | 2,016 | Jan 1, 2025 | $25,583 | $0 |
| UNITED CONCORDIA INSURANCE COMPANY | Dental | 21 | Jan 1, 2025 | $12,165 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
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