2023-05-12T08:46:00-05:00 2022-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2021-07-01 060850110 TRI-STATE JOINT FUND TRI- 2032502601 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 DENNIS MCGUIRE EMPLOYER CO-CHAIRMAN 2032502601 2023-05-08 1 DENNIS MCGUIRE 999009999 DANA HARVEY CPA P01452206 2033877771 2023-05-08 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z DENNIS MCGUIRE 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 132850875 0 X N/A X 1968 CT SELF-INSURED HEALTH BENEFIT PLAN 27 27 11 0 0 0 0 0 111601111 121373559 5136032 427479 1048 1360 116738191 121802398 0 0 108065249 118264355 1275323 1433393 0 0 0 1755020 1995181 111095592 121692929 5642599 109469 32141360 32402096 9820746 12283855 22320614 20118241 PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO MEMBERS COVERED UNDER COLLECTIVE BARGAINING AGREEMENTS NEGOTIATED BY TEAMSTER LOCALS. 0 0 THE FUND OPERATES UNDER A TRUST AGREEMENT FOR THE PURPOSEOF MAKING BENEFIT PAYMENTS TO MEMBERS OF THE TRI-STATETEAMSTERS HEALTH SERVICES & INSURANCE PLAN, THESE BENEFITS COVER HOSPITAL,SURGICAL, PRESCRIPTION DRUG, HOME HEALTH CARE AND DEATH BENEFITS FOR 11,546 MEMBERS PLUS THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 1 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 1 155 0 1 11 1 0 0 0 0 0 0 0 0 X 27 27 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 1 0 0 X SHARON AGNELLO 2032502604 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 DENNIS MCGUIRE EMPLOYER CO-CHAIRMAN & TRU 4.00 2.00 X 14000 0 0 THOMAS BAYUSIK UNION TRUSTEE 1.00 4.00 X 0 0 0 SALVATORE ABATE UNION TRUSTEE 1.00 4.00 X 0 0 0 TIMOTHY CASEY EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 ANTHONY CAPPELLA EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 FORREST HARVEY EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 EDWIN ROONEY UNION TRUSTEE 1.00 4.00 X 0 0 0 ROBERT DIGIROLAMO UNION TRUSTEE 1.00 4.00 X 0 0 0 FRANK ROSSI UNION TRUSTEE 1.00 4.00 X 0 0 0 VICTOR SANTIAGO (FORMER) UNION TRUSTEE 1.00 4.00 X 0 0 0 ROBERT SULLIVAN JR EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 LAWRENCE KEEFE EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 BEVAN SWEET UNION CO-CHAIRMAN 1.00 4.00 X 0 0 0 CRAIG MITCHELL UNION TRUSTEE 1.00 4.00 X 0 0 0 NICHOLAS REUT EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 ROARK LEVINE EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 SCOTT BLAIS EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 DONALD SHUBERT (FORMER) EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 DAVID LUCAS (FORMER) UNION TRUSTEE 1.00 4.00 X 0 0 0 ANTHONY LEPORE UNION TRUSTEE 1.00 4.00 X 0 0 0 JOHN CAPOBIANCO (FORMER) UNION CO-CHAIRMAN & TRUSTE 4.00 4.00 X 0 0 0 MICHAEL RINALDI UNION TRUSTEE 1.00 4.00 X 0 0 0 HELGA SCHMIDT EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 PAUL AYOUB EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 GLENN BARKSDALE UNION TRUSTEE 1.00 4.00 X 0 0 0 PAUL NOVAK EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 JAMES STACK EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 ROBERT ZIOBROWSKI UNION TRUSTEE 1.00 4.00 X 0 0 0 ARTHUR BELL UNION TRUSTEE 1.00 4.00 X 0 0 0 SHARON AGNELLO EXECUTIVE DIRECTOR 40.00 X 145726 0 49644 SUSAN KOSTEK IT DIRECTOR 40.00 X 106498 0 49644 266224 0 99288 2 0 1 0 THE SEGAL COMPANY CHURCH STREET STATION P O BOX 4059 NEW YORK NY 102614059 ACTUARIAL 325761 ROBERT M CHEVERIE & ASSOC 333 EAST RIVER DRIVE EAST HARTFORD CT 06108 LEGAL 321324 SM ESPOSITO & COMPANY PC 3013 DIXWELL AVE HAMDEN CT 06518 ACCOUNTING/AUDITING 290526 CHANGE HEALTHCARE PAYMENT MGMT 3055 LEBANON PIKE NASHVILLE TN 37214 PRINTING/MAILING 147154 4 CONTRIBUTIONS - HEALTH FUNDS 900099 121372489 121372489 RENTAL INCOME - AFFILIATE 900099 1070 1070 121373559 382044 382044 11093912 11048077 400 45835 -400 45435 45435 REFUNDS & REIMBURSEMENTS 900099 1360 1360 1360 121802398 121374919 0 427479 118264355 167855 670209 256907 268558 69864 320820 192170 45158 447336 293236 180204 134773 47389 91971 26333 51410 OUTSIDE SERVICES 160314 MEDICAL EQUIPMENT 4067 121692929 1764369 97532 6457783 3384101 90800 50784 519978 380254 152528 139724 20175268 18146779 3500612 10583176 32141360 32402096 1189699 1521288 8631047 10762567 9820746 12283855 X 0 0 0 0 22320614 20118241 22320614 20118241 32141360 32402096 109469 -2311842 0 X X 0 1 X 1 0 10149 2369 7780 132991 67744 65247 376838 310141 66697 139724 MISCELLANEOUS RECEIVABLE 5577895 DUE FROM AFFILIATES 3431972 SECURITY DEPOSIT 7583 HEALTH BENEFITS EXPERIENCE RECONCILIATION 1541997 INTEREST RECEIVABLE 23729 10583176 DUE TO ANTHEM 5573757 DUE TO AFFILIATES 5161010 CLAIMS INCURRED BUT NOT RECEIVED 27800 10762567 X 119490956 -2311842 -2311842 121802798 -400 -400 121802398 121685327 0 121685327 7602 7602 121692929 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN AND TO RECOGNIZE A TAX LIABILITY FOR ANY UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAX AUTHORITIES; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN FILES ITS FORM 990 IN THE U.S. FEDERAL JURISDICTION. THE PLAN BELIEVES THAT THE INCOME TAX RETURNS FOR YEARS ENDED JUNE 30, 2018 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSET -400. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION 8,000. LOSS ON DISPOSAL OF ASSET -400. ROUNDING ADJUSTMENT 2. X 0 0 0 SHARON AGNELLO EXECUTIVE DIRECTOR 145726 0 0 0 0 0 24684 0 24960 0 195370 0 0 0 SUSAN KOSTEK IT DIRECTOR 106498 0 0 0 0 0 24684 0 24960 0 156142 0 0 0 PART I, LINE 3 THE CO-CHAIRMEN REVIEW AND ADJUST THE COMPENSATION OF THE EXECUTIVE DIRECTOR ON AN ANNUAL BASIS. ABRINA CAPOBIANCO DAUGHTER IN LAW OF (FORMER) CO-CHAIR JOHN CAPOBIANCO 128106 PAYMENT OF WAGES AND BENEFITS AS A RESULT OF EMPLOYMENT WITH THE ORGANIZATION. 0 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED WITH THE CO-CHAIRMEN AND THE EXECUTIVE DIRECTOR PRIOR TO FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 15A THE CO-CHAIRMEN REVIEW AND ADJUST THE COMPENSATION OF THE EXECUTIVE DIRECTOR ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 TRI-STATE JOINT FUND DOES NOT MAKE AVAILABLE TO THE GENERAL PUBLIC ANY OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS. FORM 990, PART X11, LINE 2C OVERSIGHT RESPONSIBILITY THERE HAS BEEN NO CHANGE IN THE OVERSIGHT RESPONSIBILITY. THE TRUSTEE'S ASSUME RESPONSIBILITY FOR THE AUDIT PROCESS INCLUDING SELECTION OF THE INDEPENDENT AUDITOR. IBT TEAMSTERS LOCAL 191 HEALTH SERVICE & INSURANCE PLAN 1139 FAIRFIELD AVENUE BRIDGEPORT CT 06605 060689974 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 404 HEALTH SERVICE & INSURANCE PLAN 115 PROGRESS AVENUE SPRINGFIELD MA 01104 042174518 AFFILIATED SELF INSURED HEALTH PLAN MA 501C-9 N/A 0 TRANSPORTATION LOCAL 443 HEALTH SERVICE & INSURANCE PLAN 200 WALLACE STREET NEW HAVEN CT 06511 060690083 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 GENERAL TEAMSTERS LOCAL 493 HEALTH SERVICE & INSURANCE PLAN 18 CRESCENT STREET UNCASVILLE CT 06382 060689500 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 671A HEALTH SERVICE & INSURANCE PLAN 22 BRITTON DRIVE BLOOMFIELD CT 06002 060683663 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 677 HEALTH SERVICE & INSURANCE PLAN 1871 BALDWIN STREET WATERBURY CT 06706 060691862 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN 400 CHAPEL ROAD UNIT 2-A SOUTH WINDSOR CT 06074 060997832 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 IBT TEAMSTERS LOCAL 191 HEALTH SERVICE & INSURANCE PLAN L 687320 CASH VALUE TEAMSTERS LOCAL 404 HEALTH SERVICE & INSURANCE PLAN L 370920 CASH VALUE TRANSPORTATION LOCAL 443 HEALTH SERVICE & INSURANCE PLAN L 498520 CASH VALUE GENERAL TEAMSTERS LOCAL 493 HEALTH SERVICE & INSURANCE PLAN L 282160 CASH VALUE TEAMSTERS LOCAL 671A HEALTH SERVICE & INSURANCE PLAN L 167000 CASH VALUE TEAMSTERS LOCAL 677 HEALTH SERVICE & INSURANCE PLAN L 1014720 CASH VALUE TEAMSTERS LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN L 227600 CASH VALUE