2022-10-16T08:46:19-05:00 2021-12-31 611436956 NOVAK FRANCELLA LLC 40 MONUMENT RD 5TH FLR BALA CYNWYD PA 19004 990 2021-01-01 016010506 UA LOCAL 716 HEALTH & WELFARE TRUST FUND UALO 2032697741 10 TECHNOLOGY DRIVE WALLINGFORD CT 06492 ANTHONY SIROIS TRUSTEE 2032697741 2022-10-16 1 ANTHONY SIROIS 999009999 LOUIS VERZELLA CPA P00360279 6106689400 2022-10-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ANTHONY SIROIS 10 TECHNOLOGY DRIVE WALLINGFORD CT 06492 10035447 0 X N/A X 1977 ME TO PROVIDE VARIOUS FORMS OF HEALTH AND OTHER INSURANCE COVERAGE TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 10 0 0 0 0 0 0 0 3271037 4130106 477600 472610 320582 353684 4069219 4956400 0 0 4236511 4581105 0 0 0 0 0 558262 531248 4794773 5112353 -725554 -155953 6768953 6682151 289027 367651 6479926 6314500 TO PROVIDE VARIOUS FORMS OF HEALTH AND OTHER INSURANCE COVERAGE TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 TO PROVIDE VARIOUS FORMS OF HEALTH AND OTHER INSURANCE COVERAGE TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 10 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE ORGANIZATION 2032697741 10 TECHNOLOGY DRIVE WALLINGFORD CT 06492 NAPOLITANO JOHN TRUSTEE 2.00 40.00 X 0 43836 0 MCKENNA JENNIFER TRUSTEE 2.00 X 0 0 0 SAINO GARY TRUSTEE 2.00 X 0 0 0 PARRIE WILLIETTE TRUSTEE 2.00 X 0 0 0 SIROIS ANTHONY TRUSTEE 2.00 40.00 X 0 77955 0 CHAD ELLIS TRUSTEE 2.00 X 0 0 0 CHRISTOPHER HILL JR TRUSTEE (P) 2.00 X 0 0 0 GERRY MORIN TRUSTEE (P) 2.00 X 0 0 0 BEAU LIBBY TRUSTEE 2.00 X 0 0 0 DONALD TURNBULL JR TRUSTEE 2.00 X 0 0 0 MICHAEL WICHENBACH TRUSTEE 2.00 X 0 47322 0 0 169113 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 10 TECHNOLOGY DRIVE WALLINGFORD CT 06492 ADMINISTRATION 216392 ANTHEM INC 120 MONUMENT CIRCLE INDIANAPOLIS IN 46204 NETWORK ACCES/CLAIMS REPRICING 135025 2 EMPLOYER CONTRIBUTIONS 230000 3814873 3814873 EMPLOYEE CONTRIBUTIONS 230000 315233 315233 4130106 94055 94055 5457602 5079047 378555 378555 378555 STOP LOSS REIMBURSEMENTS 230000 183927 183927 PRESCRIPTION REBATES 230000 152579 152579 MEDICARE PART D REIMBURSEMENT 230000 17178 17178 353684 4956400 4862345 0 94055 4581105 216392 38124 19547 26452 210872 5200 2751 239 5593 BANK FEES 4599 PCORI FEES 1479 5112353 13873 224168 33527 40645 635264 690897 6086289 5726441 6768953 6682151 13728 19230 275299 348421 289027 367651 X 0 0 0 0 6479926 6314500 6479926 6314500 6768953 6682151 -155953 -9473 0 X X 0 1 X 1 0 0 BENEFIT OBLIGATIONS 348421 348421 X 4920475 -9473 -9473 4929948 26452 26452 4956400 5012779 0 5012779 26452 73122 99574 5112353 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT, MORE LIKELY THAN NOT, WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFITS PAYABLE 73,122. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 WAS PROVIDED TO ORGANIZATIONS GOVERNING BODY VIA EMAIL OR PAPER COPY. THE FORM 990 WAS REVIEWED BY THE TRUSTEE SIGNING THE RETURN AS WELL AS LEGAL COUNSEL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IN ACCORDANCE WITH THE ORGANIZATION'S POLICY, INDIVIDUALS HAVE A CONTINUOUS OBLIGATION TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST. AS PART OF THE FORM 990 REVIEW PROCESS, THE ORGANIZATION DISCUSSES THE POLICY AND THE DISCLOSURE OBLIGATIONS THEREUNDER ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, INSTRUMENTS UNDER WHICH THE ORGANIZATION IS OPERATED OR ESTABLISHED, AND FINANCIAL STATEMENTS, ARE AVALIABLE UPON REQUEST TO PARTICIPANTS, EMPLOYERS, AND OTHERS IN ACCORDANCE WITH GOVERNMENT REGULATIONS, BUT ARE NOT AVAILABLE TO THE GENERAL PUBLIC. FORM 990. PART XII, LINE 2C: THE BOARD OF TRUSTEES OVERSEES THE FINANCIAL STATEMENT AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT. NO CHANGE FROM PRIOR YEAR. 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