2015-02-11T10:29:47-06:00 2014-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2013-07-01 060850110 TRI-STATE JOINT FUND TRI- 2038763110 25 RESEARCH DRIVE MILFORD CT 06460 JOHN CAPOBIANCO UNION CO-CHAIRMAN 2038763103 2015-02-07 1 DANA HARVEY CPA P01452206 2033877771 2015-02-07 2013 2016-03-07 17:11:31Z JOHN CAPOBIANCO 25 RESEARCH DRIVE MILFORD CT 06460 87617615 0 X N/A X 1968 CT SELF-INSURED HEALTH BENEFIT PLAN 28 28 15 0 0 0 0 0 79663104 81503332 579332 751679 1784 2749 80244220 82257760 0 0 77421276 78612981 1323716 1354835 0 0 0 1645505 1685003 80390497 81652819 -146277 604941 15369983 20121384 3064550 6421808 12305433 13699576 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 11,068 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 0 0 0 0 0 0 0 1 0 0 1 X 19 0 1 15 1 0 0 0 0 0 0 X 28 28 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 1 0 X SHARON AGNELLO 2038763103 25 RESEARCH DRIVE MILFORD CT 06460 DENNIS RAYMOND UNION CO-CHAIRMAN & TRUSTE 4.00 4.00 X 0 0 0 DANIEL FLANAGAN UNION TRUSTEE 1.00 4.00 X 0 0 0 THOMAS BAYUSIK UNION TRUSTEE 1.00 4.00 X 0 0 0 ANTHONY CAPPELLA EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 RAYMOND ONEGLIA EMPLOYER TRUSTEE 1.00 2.00 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 SCOTT THOMSON EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 DENNIS MCGUIRE EMPLOYER CO-CHAIRMAN & TRU 4.00 2.00 X 0 0 0 THOMAS SCHLINK UNION TRUSTEE 1.00 4.00 X 0 0 0 BEVAN SWEET UNION TRUSTEE 1.00 4.00 X 0 0 0 NICHOLAS REUT EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 JOHN LUPACCHINO UNION TRUSTEE 1.00 4.00 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 DANIEL DURSO UNION TRUSTEE 1.00 4.00 X 0 0 0 ALAN FREOHLICH EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 CHRISTOPHER ROOS 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 TIMOTHY CASEY EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 HELGA SCHMIDT EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 PATRICIA SANDILLO EXECUTIVE DIRECTOR 40.00 X 134881 0 36000 KENNETH PAUZE EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 JOHN CAPOBIANCO UNION TRUSTEE 1.00 4.00 X 0 0 0 ROBERT FLYNN UNION TRUSTEE 1.00 4.00 X 0 0 0 ED ROONEY UNION TRUSTEE 1.00 4.00 X 0 0 0 134881 0 36000 1 0 1 0 ROBERT M CHEVERIE & ASSOC 333 EAST RIVER DRIVE EAST HARTFORD CT 06108 LEGAL 319746 THE SEGAL COMPANY CHURCH STREET STATION P O BOX 4059 NEW YORK NY 102614059 ACTUARIAL 242305 SM ESPOSITO & COMPANY PC 3013 DIXWELL AVE HAMDEN CT 06763 ACCOUNTING/AUDITING 177480 EMDEONABF 3183 RIDER TRAIL SOUTH EARTH CITY MO 63045 PRINTING/MAILING 128496 4 CONTRIBUTIONS - HEALTH FUNDS 900099 81503332 81503332 81503332 224623 224623 5886911 5359855 527056 527056 527056 SECURITY LITIGATION PROCEEDS 900099 1549 1549 RENTAL INCOME 900099 1200 1200 2749 82257760 81506081 0 751679 78612981 134881 625410 277868 250430 66246 361746 177480 72876 285939 415893 110962 32115 40295 57307 49430 OUTSIDE SERVICES 80960 81652819 89016 2677430 5819994 1255515 44995 93866 4826628 4391384 452721 435244 11378478 11008737 816359 1419012 15369983 20121384 1162359 1506442 1902191 4915366 3064550 6421808 X 0 0 0 0 12305433 13699576 12305433 13699576 15369983 20121384 604941 789202 0 X X 0 1 X 1 0 152788 152788 3673019 3451644 221375 23081 20773 2308 977740 918967 58773 435244 INTEREST RECEIVABLE 24504 MISCELLANEOUS RECEIVABLE 1394508 1419012 DUE TO ANTHEM 3727681 DUE TO AFFILIATES 961477 HEALTH BENEFIT RECONCILIATION 194208 CLAIMS INCURRED BUT NOT RECEIVED 32000 4915366 X 83046962 789202 789202 82257760 0 82257760 81620819 0 81620819 32000 32000 81652819 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, 2010 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION 32,000. 0 0 0 PATRICIA SANDILLO EXECUTIVE DIRECTOR 134881 0 0 0 0 0 0 0 36000 0 170881 0 0 0 FORM 990, PART V, LINE 2A FORMS W-2: TRISTATE JOINT FUND ALSO ISSUES FOMRS W-2 FOR THE DISABILITY (THIRD PARTY SICK PAY) OFFERED BY THE PLAN. THERE WERE A TOTAL OF 259 W-2'S ISSUED FOR THIS BENEFIT FOR THE CALENDAR YEAR 2013. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED IN PERSON WITH THE CO-CHAIRMEN AND THE EXECUTIVE DIRECTOR PRIOR TO FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 15B 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 RESPONBILBILITY 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 CRESENT STREET UNCASVILLE CT 06382 060689500 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 559 HEALTH SERVICE & INSURANCE PLAN 400 CHAPEL ROAD UNIT 2-B SOUTH WINDSOR CT 06074 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 656720 TEAMSTERS LOCAL 404 HEALTH SERVICE & INSURANCE PLAN L 351240 TRANSPORTATION LOCAL 443 HEALTH SERVICE & INSURANCE PLAN L 479520 GENERAL TEAMSTERS LOCAL 493 HEALTH SERVICE & INSURANCE PLAN L 265040 TEAMSTERS LOCAL 559 HEALTH SERVICE & INSURANCE PLAN L 214560 TEAMSTERS LOCAL 677 HEALTH SERVICE & INSURANCE PLAN L 783640 TEAMSTERS LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN L 265520