2021-05-14T07:40:27-05:00 2020-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2019-07-01 060850110 TRI-STATE JOINT FUND TRI- 2032502601 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 JOHN CAPOBIANCO UNION CO-CHAIRMAN 2032502601 2021-05-13 1 DANA HARVEY CPA P01452206 2033877771 2021-05-13 2019 2022-09-23 18:48:47Z JOHN CAPOBIANCO 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 109210780 0 X N/A X 1968 CT SELF-INSURED HEALTH BENEFIT PLAN 28 28 11 0 0 0 0 0 104657138 100819391 1293800 794988 197 63013 105951135 101677392 0 0 101639636 97605952 1247140 1243654 0 0 0 1759675 1775933 104646451 100625539 1304684 1051853 25624574 27508191 8727852 9328506 16896722 18179685 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 11,701 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 12 0 1 11 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 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-CHARIMAN & 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 CHRISTOPHER ROOS (FORMER) UNION TRUSTEE 1.00 4.00 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 SHARON AGNELLO EXECUTIVE DIRECTOR 40.00 X 134991 0 46684 ROBERT ZIOBROWSKI UNION TRUSTEE 1.00 4.00 X 0 0 0 SUSAN KOSTEK IT DIRECTOR 40.00 X 105931 0 46684 240922 0 93368 2 0 1 0 ROBERT M CHEVERIE & ASSOC 333 EAST RIVER DRIVE EAST HARTFORD CT 06108 LEGAL 321765 THE SEGAL COMPANY CHURCH STREET STATION P O BOX 4059 NEW YORK NY 102614059 ACTUARIAL 291478 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 137933 4 CONTRIBUTIONS - HEALTH FUNDS 900099 100818491 100818491 RENTAL INCOME -AFFILIATE 900099 900 900 100819391 300772 300772 8027604 7533388 494216 494216 494216 REFUNDS & REIMBURSEMENTS 900099 63013 63013 63013 101677392 100882404 0 794988 97605952 708772 241730 234067 59085 321766 176280 59253 410203 260028 151585 129025 28404 24993 22453 50213 OUTSIDE SERVICES 137933 MEDICAL EQUIPMENT 3797 100625539 105258 101752 3606676 7080257 52317 77074 507679 379514 139064 128165 14011047 15014895 7710212 5106048 25624574 27508191 1184113 1066949 7543739 8261557 8727852 9328506 X 0 0 0 0 16896722 18179685 16896722 18179685 25624574 27508191 1051853 231110 0 X X 0 1 X 1 0 10148 1015 9133 127986 79339 48647 369545 299160 70385 128165 MISCELLANEOUS RECEIVABLE 4536557 DUE FROM AFFILIATES 561908 SECURITY DEPOSIT 7583 5106048 DUE TO ANTHEM 2569557 DUE TO AFFILIATES 4428419 CLAIMS INCURRED BUT NOT RECEIVED 19100 DUE TO PARTICIPATING HEALTH SERVICES 1244481 8261557 X 101908502 231110 231110 101677392 0 101677392 100629939 0 100629939 -4400 -4400 100625539 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, 2016 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: FOUNDING ADJUSTMENT PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION -4,400. X 0 0 0 SHARON AGNELLO EXECUTIVE DIRECTOR 134991 0 0 0 0 0 24684 0 22000 0 181675 0 0 0 SUSAN KOSTEK IT DIRECTOR 105931 0 0 0 0 0 24684 0 22000 0 152615 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 105094 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 667920 CASH VALUE TEAMSTERS LOCAL 404 HEALTH SERVICE & INSURANCE PLAN L 347320 CASH VALUE TRANSPORTATION LOCAL 443 HEALTH SERVICE & INSURANCE PLAN L 479000 CASH VALUE GENERAL TEAMSTERS LOCAL 493 HEALTH SERVICE & INSURANCE PLAN L 252000 CASH VALUE TEAMSTERS LOCAL 671A HEALTH SERVICE & INSURANCE PLAN L 181280 CASH VALUE TEAMSTERS LOCAL 677 HEALTH SERVICE & INSURANCE PLAN L 959560 CASH VALUE TEAMSTERS LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN L 261560 CASH VALUE