2022-05-12T10:48:40-05:00 2021-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2020-07-01 060850110 TRI-STATE JOINT FUND TRI- 2032502601 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 DENNIS MCGUIRE EMPLOYER CO-CHAIRMAN 2032502601 2022-05-12 1 DENNIS MCGUIRE 999009999 DANA HARVEY CPA P01452206 2033877771 2022-05-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DENNIS MCGUIRE 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 130899372 0 X N/A X 1968 CT SELF-INSURED HEALTH BENEFIT PLAN 28 28 10 0 0 0 0 0 100819391 111601111 794988 5136032 63013 1048 101677392 116738191 0 0 97605952 108065249 1243654 1275323 0 0 0 1775933 1755020 100625539 111095592 1051853 5642599 27508191 32141360 9328506 9820746 18179685 22320614 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 11,609 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 11 0 1 10 1 0 0 0 0 0 0 0 0 X 28 28 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 0 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 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 TRUSTEE 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 CRAIG TIMPSON (FORMER) EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 SCOTT BLAIS EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 DONALD SHUBERT EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 DAVID LUCAS UNION TRUSTEE 1.00 4.00 X 0 0 0 ANTHONY LEPORE UNION TRUSTEE 1.00 4.00 X 0 0 0 JOHN CAPOBIANCO 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 SHARON AGNELLO EXECUTIVE DIRECTOR 40.00 X 144244 0 49231 SUSAN KOSTEK IT DIRECTOR 40.00 X 111852 0 49231 256096 0 98462 2 0 1 0 ROBERT M CHEVERIE & ASSOC 333 EAST RIVER DRIVE EAST HARTFORD CT 06108 LEGAL 313975 THE SEGAL COMPANY CHURCH STREET STATION P O BOX 4059 NEW YORK NY 102614059 ACTUARIAL 310184 SM ESPOSITO & COMPANY PC 3013 DIXWELL AVE HAMDEN CT 06518 ACCOUNTING/AUDITING 284280 CHANGE HEALTHCARE PAYMENT MGMT 3055 LEBANON PIKE NASHVILLE TN 37214 PRINTING/MAILING 153166 4 CONTRIBUTIONS - HEALTH FUNDS 900099 111601111 111601111 111601111 195244 195244 19101969 14160585 596 4941384 -596 4940788 -596 4941384 REFUNDS & REIMBURSEMENTS 900099 1048 1048 1048 116738191 111601563 0 5136628 108065249 259096 471154 241528 243232 60313 313975 176280 40346 428364 253798 157008 140894 12115 2710 24885 46548 OUTSIDE SERVICES 153166 MEDICAL EQUIPMENT 4931 111095592 101752 1764369 7080257 6457783 77074 90800 515694 363166 128165 152528 15014895 20175268 5106048 3500612 27508191 32141360 1066949 1189699 8261557 8631047 9328506 9820746 X 0 0 0 0 18179685 22320614 18179685 22320614 27508191 32141360 5642599 -1501670 0 X X 0 1 X 1 0 10148 1692 8456 140445 63393 77052 365101 298081 67020 152528 MISCELLANEOUS RECEIVABLE 2115951 DUE FROM AFFILIATES 1117501 SECURITY DEPOSIT 7583 HEALTH BENEFITS EXPERIENCE RECONCILIATINO 257796 INTEREST RECEIVABLE 1781 3500612 DUE TO ANTHEM 5440029 DUE TO AFFILIATES 3171218 CLAIMS INCURRED BUT NOT RECEIVED 19800 8631047 X 115236520 -1501670 -1501670 116738190 1 1 116738191 111094891 0 111094891 701 701 111095592 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, 2017 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: FOUNDING ADJUSTMENT 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION 700. ROUNDING ADJUSTMENT 1. X 0 0 0 SHARON AGNELLO EXECUTIVE DIRECTOR 144244 0 0 0 0 0 24684 0 24547 0 193475 0 0 0 SUSAN KOSTEK IT DIRECTOR 111852 0 0 0 0 0 24684 0 24547 0 161083 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 CO-CHAIR JOHN CAPOBIANCO 121670 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 707840 CASH VALUE TEAMSTERS LOCAL 404 HEALTH SERVICE & INSURANCE PLAN L 360240 CASH VALUE TRANSPORTATION LOCAL 443 HEALTH SERVICE & INSURANCE PLAN L 498160 CASH VALUE GENERAL TEAMSTERS LOCAL 493 HEALTH SERVICE & INSURANCE PLAN L 286600 CASH VALUE TEAMSTERS LOCAL 671A HEALTH SERVICE & INSURANCE PLAN L 173960 CASH VALUE TEAMSTERS LOCAL 677 HEALTH SERVICE & INSURANCE PLAN L 997400 CASH VALUE TEAMSTERS LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN L 240680 CASH VALUE