2024-05-15T08:37:28-05:00 2023-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2022-07-01 060691862 LOCAL 677 HEALTH SERVICE AND INSURANCE PLAN LOCA 2037552906 609 WEST JOHNSON AVE CHESHIRE CT 06410 JOHN MURPHY UNION TRUSTEE 2037552906 2024-05-13 1 JOHN MURPHY 999009999 0 DANA HARVEY CPA P01452206 2033877771 2024-05-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOHN MURPHY 1871 BALDWIN STREET WATERBURY CT 06706 81852698 0 X N/A X 1958 CT SELF-INSURED HEALTH BENEFIT PLAN X 1 1 6 0 0 0 0 0 41390428 13809656 3767192 15022516 2145 4150 45159765 28836322 0 0 48184601 15783439 789416 330541 0 0 0 2173850 1174882 51147867 17288862 -5988102 11547460 95770287 1841420 8657932 12307 87112355 1829113 PROVIDE SELF INSURED HEALTH BENEFITS TO MEMBERS COVERED UNDER A COLLECTIVE BARGAINING AGREEMENT NEGOTIATED BY THE TEAMSTER LOCAL 677 UNION. 0 0 PROVIDED INSURED AND SELF-INSURED MEDICAL, DEATH & LIFEINSURANCE BENEFITS TO APPROXIMATELY 3,000 MEMBERS PLUS THEIR DEPENDENTS UP UNTIL DECEMEBER 31, 2022. 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 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 1 0 0 6 1 0 0 0 0 0 0 0 0 X 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 X JOHN MURPHY 2037552906 609 WEST JOHNSON AVE CHESHIRE CT 06410 PAUL AYOUB (FORMER) EMPLOYER TRUSTEE 2.00 X 0 0 0 HELGA SCHMIDT (FORMER) EMPLOYER TRUSTEE 2.00 X 2800 0 0 MICHAEL RINALDI (FORMER) UNION TRUSTEE 4.00 50.00 X 0 0 0 JOHN MURPHY UNION TRUSTEE 4.00 20.00 X 0 0 0 2800 0 0 0 0 0 0 ANTHEM BLUE CROSS BLUE SHIELD 1351 WM HOWARD TAFT RD CINCINNATI OH 45206 REPRICING & ADMIN FEES 351185 1 EMPLOYER CONTRIBUTIONS 900099 13761032 13761032 COBRA CONTRIBUTIONS 900099 42966 42966 SPECIAL RETIREE CONTRIBUTIONS 900099 5658 5658 13809656 1321576 1321576 66717316 52993920 22456 13723396 -22456 13700940 13700940 REFUNDS & REIMBURSEMENTS 900099 4150 4150 4150 28836322 13813806 0 15022516 15783439 2800 187795 54993 69518 15435 60493 98792 879356 17972 17115 8180 2444 90530 17288862 368680 649389 4552663 3636259 2918 0 24900 86931028 253839 1192031 95770287 1841420 89337 12307 8568595 0 8657932 12307 X 0 0 0 0 87112355 1829113 87112355 1829113 95770287 1841420 X 11547460 -8135225 -88695477 X X 0 1 X 1 0 0 PAYROLL AUDITS RECEIVABLE 122832 DUE FROM HEALTH BENEFIT RECONCILIATION 1069199 1192031 X 20633808 -8135225 -8135225 28769033 89745 -22456 67289 28836322 23756940 22456 22456 23734484 89745 -6535367 -6445622 17288862 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 TAX 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 PERIODS IN PROGRESS. THE PLAN BELIEVES THAT THE INCOME TAX RETURNS FOR THE YEARS ENDED JUNE 30, 2019 AND PRIOR ARE CLOSED YEARS AND ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSITON OF OFFICE EQUIPMENT -22,456. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSITION OF OFFICE EQUIPMENT 22,456. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION -6,535,368. ROUNDING ADJUSTMENT 1. CASH AND SECURITIES (STOCKS, BONDS AND REGISTERED INVESTMENT COMPANIES) 2023-04-30 30140135 CASH VALUE AND QUOTED MARKET PRICES FOR SECURITIES. 060689974 LOCAL 191 HEALTH SERVICE AND INSURANCE PLAN 1139 FARIFIELD AVENUE BRIDGEPORT CT 06605 501(C)(9) CASH AND SECURITIES (STOCKS, BONDS AND REGISTERED INVESTMENT COMPANIES) 2023-04-30 26445478 CASH VALUE AND QUOTED MARKET PRICES FOR SECURITIES. 060690083 LOCAL 443 HEALTH SERVICE & INSURANCE PLAN PO BOX 1710 NEW HAVEN CT 06507 501(C)(9) CASH AND SECURITIES (STOCKS, BONDS AND REGISTERED INVESTMENT COMPANIES) 2023-04-30 6830201 CASH VALUE AND QUOTED MARKET PRICES FOR SECURITIES. 060689500 LOCAL 493 HEALTH SERVICE & INSURANCE PLAN PO BOX 485 UNCASVILLE CT 06382 501(C)(9) CASH AND SECURITIES (STOCKS, BONDS AND REGISTERED INVESTMENT COMPANIES) 2023-04-30 14180799 CASH VALUE AND QUOTED MARKET PRICES FOR SECURITIES. 060683663 LOCAL 671A HEALTH SERVICE & INSURANCE PLAN 18 BRITTON DRIVE BLOOMFIELD CT 06002 501(C)(9) CASH AND SECURITIES (STOCKS, BONDS AND REGISTERED INVESTMENT COMPANIES) 2023-04-30 11098864 CASH VALUE AND QUOTED MARKET PRICES FOR SECURITIES. 060997832 LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN 400 CHAPEL STREET SOUTH WINDSOR CT 06074 501(C)(9) 1 0 0 0 1 0 0 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: PAUL AYOUB PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: PAUL AYOUB WAS FROMERLY AN EMPLOYER TRUSTEE OF THIS PLAN AND HAS NOW ASSUMED THE ROLE OF AN EMPLOYER TRUSTEE ON LOCAL 1035 HEALTH SERVICE AND INSURANCE PLAN. FORM 990, SCHEDULE N, PART I DURING THE PLAN YEAR LOCAL 677 HEALTH SERVICE AND INSURANCE PLAN CEASED ITS OPERATIONS AS A RESULT OF THE CLOSING OF SPONSORING UNION TEAMSTERS LOCAL 677. AS OF JANUARY 1 2023 ALL CONTRIBUTING EMPLOYERS AND PLAN PARTICIPANTS WERE TRANSFERRED TO OTHER UNION SPONSORED PLANS WITHIN THE STATE OF CONNECTICUT. THE RECEIVING PLANS WERE AFFILIATES OF TRISTATE (RELATED ORGANIZATION) AND MAINTAINED THE SAME PLAN OF BENEFITS. ASSETS WERE TRANSFERRED TO THE OTHER PLANS ON A PER CAPITA BASIS BASED ON WHICH UNION RECEIVED THE EMPLOYER AND THE RELATED UNION MEMBERS WORKING UNDER A CBA. THE FINAL TRANSFER WILL BE MADE ONCE ALL RECONCILING ITEMS SUCH AS BENEFIT PAYMENTS, REBATES AND GUARANTEES ARE COMPLETED. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO APPLICABLE COMMITTEE WITH THE AUTHORITY TO ACT ON BEHALF OF THE EXECUTIVE BOARD FOR WHICH MINUTES WOULD NEED TO BE RECORDED. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED IN PERSON WITH CERTAIN MEMBERS OF THE BOARD OF TRUSTEES PRIOR TO FILING OF THE RETURN. FORM 990, PART VI, SECTION C, LINE 19 THE HEALTH SERVICE & INSURANCE PLAN DOES NOT MAKE AVAILABLE TO THE GENERAL PUBLIC ANY OF ITS GOVERNING DOCUMENTS OR FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9: TRANSFER OF PLAN ASSETS TO AFFILIATES DUE TO DISSOLUTION -88,695,477. 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 LOCAL UNION 677 1871 BALDWIN STREET WATERBURY CT 06706 060389865 REPRESENTATION OF UNION MEMBERS CT 501C-5 N/A 0 TRI STATE JOINT FUND 609 WEST JOHNSON AVE 2ND FLOOR CHESHIRE CT 06410 060850110 3RD PARTY ADMINISTRATOR FOR AFFILIATED ENTITIES CT 501C-9 N/A 0 BRUNALI CONSTRUCTION CO PO BOX 112 SOUTHINGTON CT 06489 CT C 0 CITY OF DANBURY 155 DEER HILL AVE DANBURY CT 06810 CT C 0 DALY & SONS INC 110 MATTATUCK HEIGHTS WATERBURY CT 06705 CT C 0 THE DRAWN METAL TUBE COMPANY PO BOX 218 MIDDLE VILLAGE NY 11379 NY C 0 A FIORILLO & COMAPNY 396 CLARK STREET MILLDALE CT 06467 CT C 0 TOWN OF NEW MILFORD 10 MAIN STREET NEW MILFORD CT 06776 CT C 0 NEW PENN MOTOR EXPRESS 625 SO FIFTH STREET LEBANON PA 17042 PA C 0 NORTHEAST TRANS CO 1717 THOMASTON AVE WATERBURY CT 06704 CT C 0 O&G INDUSTRIES INC PO BOX 907 TORRINGTON CT 06790 CT C 0 POMPERAUG REGIONAL SCHOOL 15 PO BOX 395 MIDDLEBURY CT 06762 CT C 0 YRC INC 10990 ROE AVE OVERLAND PARK KS 66211 KS C 0 UNITED PARCEL SERVICE 100 EAST CAMPUS VIEW BLVD COLUMBUS OH 43235 OH C 0 SUZIO CONSTRUCTION CO WESTFIELD ROAD MERIDEN CT 06450 CT C 0 TOWN OF MIDDLEBURY 1212 WHITTEMORE ROAD MIDDLEBURY CT 06762 CT C 0 TOWN OF OXFORD 426 OXFORD ROAD OXFORD CT 06483 CT C 0 WACO SCAFFOLDING CO INC 1247 HIGHLAND AVENUE CHESHIRE CT 06410 CT C 0 YORK TRAP ROCK QUARRY CO WESTFIELD ROAD MERIDEN CT 06450 CT C 0 J IAPALUCCIO INC 425 FEDERAL ROAD BROOKFIELD CT 06804 CT C 0 THE QUAKER CORPORATION PO BOX 368 CHESHIRE CT 06410 CT C 0 CORESLAB STRUCTURES INC PO BOX 279 THOMASTON CT 06787 CT C 0 VEOLIA WATER SEYMOUR VWNA EAST 723 DERBY AVE SEYMOUR CT 06483 CT C 0 VEOLIA WATER DANBURY NEWTOWN ROAD DANBURY CT 06810 CT C 0 TOWN OF ROXBURY 29 NORTH STREET ROXBURY CT 06783 CT C 0 CONSOLIDATED INDUSTRIES 677 MIXVILLE ROAD CHESHIRE CT 06410 CT C 0 GRIFFIN HOSPITAL 130 DIVISION STREET DEBRY CT 06518 CT C 0 INTERSTATE & LAKELAND LUMBER 247 MILL STREET GREEWICH CT 06830 CT C 0 PETRO HOLDINGS PO BOX 283 TIVERTON RI 02878 RI C 0 TOWN OF NEW FAIRFIELD 4 BRUSH HILL ROAD NEW FAIRFIELD CT 06812 CT C 0 TOWN OF SHERMAN PO BOX 39 MALLERY SHERMAN CT 06784 CT C 0 ANSONIA BOARD OF EDUCATION 42 GROVE STREET ANSONIA CT 06401 CT C 0 TOWN OF BRIDGEWATER PO BOX 216 BRIDGEWATER CT 06752 CT C 0 TOWN OF SOUTHBURY 501 MAIN STREET SOUTHBURY CT 06488 CT C 0 REGIONAL SCHOOL DISTRICT NO 14 5 MINORTOWN RAOD WOODBURY CT 06798 CT C 0 METALLON INC 1415 WATERBURY ROAD THOMASTON CT 06787 CT C 0 DANBURY BOARD OF EDUCATION 63 BEAVER BROOK ROAD DANBURY CT 06810 CT C 0 TOWN OF SHARON PO BOX 385 SHARON CT 06069 CT C 0 THE COCA-COLA COMPANY 1 COCA-COLA PLZ NW ATLANTA GA 30313 GA C 0 CITY OF ANSONIA 1 NORTH DIVISION STREET ANSONIA CT 06401 CT C 0 BORGGAARD CONSTRUCTION CORP 70 CREEPER HILL RD NORTH GRAFTON MA 01536 MA C 0 I-84 CONSTRUCTORS 130 SCOTT RD WATERBURY CT 06705 CT C 0 PAGANELLI CONSTRUCTION 51 LAWNACRE RD WINDSOR LOCKS CT 06096 CT C 0 SUPREME INDUSTRIES INC 216 LOWER BOGUE RD HARWINTON CT 06791 CT C 0 WALSH CONSTRUCTION 100 RIVER RIDGE DR NORWOOD MA 02062 MA C 0 EMPIRE PAVING INC 30 BERNHARD RD NORTH HAVEN CT 06473 CT C 0 TOWN OF PLYMOUTH 80 S MAIN STREET TERRYVILLE CT 06786 CT C 0 HERITAGE VILLAGE 450 HERITAGE VILLAGE SOUTHBURY CT 06488 CT C 0 SOMERS THIN STRIP 215 PIEDMONT STREET WATERBURY CT 06706 CT C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 0 0 TRISTATE JOINT FUND M 519675 CASH VALUE