TEAMSTERS HEALTH SERVICES AND INSURANCE PLAN OF LOCAL UNION 404: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization: TEAMSTERS HEALTH SERVICES AND INSURANCE PLAN OF LOCAL UNION 404 (EIN 04-2174518)
Tax period: 2022-07-01 to 2023-06-30
Filed: 2024-05-09
IRS object ID: 202421309349303712
Schema version: 2022v5.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule D
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2024-05-09T13:15:35-05:00	ReturnTs
Tax Period End	2023-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	061298465	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	SM ESPOSITO & CO PC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	3013 DIXWELL AVENUE	AddressLine1Txt
City	HAMDEN	CityNm
State Abbreviation	CT	StateAbbreviationCd
ZIP	06518	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2022-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	042174518	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	TEAMSTERS HEALTH SERVICES & INSURANCE	BusinessNameLine1Txt
Business Name Line2	PLAN OF LOCAL UNION 404	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	TEAM	BusinessNameControlTxt
Phone	4137332191	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	115 PROGRESS AVENUE	AddressLine1Txt
City	SPRINGFIELD	CityNm
State Abbreviation	MA	StateAbbreviationCd
ZIP	01104	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	FRANK A ROSSI	PersonNm
Person Title	UNION TRUSTEE	PersonTitleTxt
Phone	4137332191	PhoneNum
Signature	2024-05-07	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	FRANK	PersonFirstNm
Person Last	ROSSI	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Field	Value	IRS element (for citing)
IRS Responsible Prty Info Curr	0	IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	DANA HARVEY CPA	PreparerPersonNm
PTIN	P01452206	PTIN
Phone	2033877771	PhoneNum
Preparation	2024-05-06	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2022	TaxYr
Build TS	2023-04-26 12:10:37Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	BRYAN DONOVAN	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	115 PROGRESS AVENUE	AddressLine1Txt
City	SPRINGFIELD	CityNm
State Abbreviation	MA	StateAbbreviationCd
ZIP	01104	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$52,580,199	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c	Yes (X)	Organization501cInd
Website Address	N/A	WebsiteAddressTxt
Type Of Organization Trust	Yes (X)	TypeOfOrganizationTrustInd
Formation	1954	FormationYr
Legal Domicile State	MA	LegalDomicileStateCd
Activity Or Mission	SELF-INSURED HEALTH BENEFIT PLAN	ActivityOrMissionDesc
Voting Members Governing Body	4	VotingMembersGoverningBodyCnt
Voting Members Independent	4	VotingMembersIndependentCnt
Total Employee	2	TotalEmployeeCnt
Total Volunteers	0	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$0	PYContributionsGrantsAmt
CY Contributions Grants	$0	CYContributionsGrantsAmt
PY Program Service Revenue	$16,125,619	PYProgramServiceRevenueAmt
CY Program Service Revenue	$15,720,805	CYProgramServiceRevenueAmt
PY Investment Income	$8,761,831	PYInvestmentIncomeAmt
CY Investment Income	$4,476,236	CYInvestmentIncomeAmt
PY Other Revenue	$4,913	PYOtherRevenueAmt
CY Other Revenue	$653	CYOtherRevenueAmt
PY Total Revenue	$24,892,363	PYTotalRevenueAmt
CY Total Revenue	$20,197,694	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$7,699,294	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$8,598,921	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$255,719	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$271,659	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,146,079	PYOtherExpensesAmt
CY Other Expenses	$1,252,908	CYOtherExpensesAmt
PY Total Expenses	$9,101,092	PYTotalExpensesAmt
CY Total Expenses	$10,123,488	CYTotalExpensesAmt
PY Revenues Less Expenses	$15,791,271	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$10,074,206	CYRevenuesLessExpensesAmt
Total Assets BOY	$145,964,552	TotalAssetsBOYAmt
Total Assets EOY	$168,128,456	TotalAssetsEOYAmt
Total Liabilities BOY	$1,204,518	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$1,664,749	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$144,760,034	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$166,463,707	NetAssetsOrFundBalancesEOYAmt
Mission	PROVIDE SELF INSURED HEALTH BENEFITS TO MEMBERS COVERED UNDER A COLLECTIVE BARGAINING AGREEMENT NEGOTIATED BY THE TEAMSTERS LOCAL 404 UNION.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Desc	PROVIDES INSURED AND SELF-INSURED MEDICAL, DEATH & LIFEINSURANCE BENEFITS TO 1,372 ACTIVE AND RETIRED MEMBERS PLUS THEIR DEPENDENTS.	Desc
Described In Section501c3	0	DescribedInSection501c3Ind
Schedule B Required	0	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	12	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	2	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	4	GoverningBodyVotingMembersCnt
Independent Voting Member	4	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	0	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	0	ConflictOfInterestPolicyInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	0	CompensationProcessCEOInd
Compensation Process Other	0	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BRYAN DONOVAN	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	4137332191	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	115 PROGRESS AVENUE	AddressLine1Txt
City	SPRINGFIELD	CityNm
State Abbreviation	MA	StateAbbreviationCd
ZIP	01104	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
FRANK ROSSI
UNION TRUSTEE	4.00	Yes (X)	$7,700	$0	$0
ROBERT SULLIVAN JR
EMPLOYER TRUSTEE	2.00	Yes (X)	$9,800	$0	$0
LAWRENCE KEEFE
EMPLOYER TRUSTEE	2.00	Yes (X)	$9,100	$0	$0
BRYAN DONOVAN
UNION TRUSTEE	4.00	Yes (X)	$0	$107,550	$60,369	55.00

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$26,600	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$107,550	TotReportableCompRltdOrgAmt
Total Other Compensation	$60,369	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	0	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ANTHEM BLUE CROSS BLUE SHIELD	BusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1351 WM HOWARD TAFT RD	AddressLine1Txt
City	CINCINNATI	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	45206	ZIPCd

Field	Value	IRS element (for citing)
Services	REPRICING & ADMIN FEES	ServicesDesc
Compensation	$254,699	CompensationAmt

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	1	CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
EMPLOYER CONTRIBUTIONS	900099	$15,457,321	$15,457,321
SPECIAL RETIREE CONTRIBUTIONS	900099	$121,062	$121,062
PAYROLL AUDIT CONTRIBUTIONS	900099	$69,392	$69,392
AFFILIATED RENTAL INCOME	900099	$52,626	$52,626
COBRA CONTRIBUTIONS	900099	$20,404	$20,404

Field	Value	IRS element (for citing)
Total Program Service Revenue	$15,720,805	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,379,384	TotalRevenueColumnAmt
Exclusion	$3,379,384	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$33,479,357	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$32,382,505	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$1,096,852	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,096,852	TotalRevenueColumnAmt
Exclusion	$1,096,852	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	REFUNDS & REIMBURSMENTS	Desc
Business	900099	BusinessCd
Total Revenue Column	$653	TotalRevenueColumnAmt
Related Or Exempt Func Income	$653	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$653	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$20,197,694	TotalRevenueColumnAmt
Related Or Exempt Func Income	$15,721,458	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$4,476,236	ExclusionAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$8,598,921	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$26,600	TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$111,753	TotalAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$69,264	TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$54,582	TotalAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$9,460	TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$18,600	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$291,787	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$699,395	TotalAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$18,108	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$134,778	TotalAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$29,754	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$2,050	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$34,055	TotalAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$24,381	TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$10,123,488	TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$79,622	BOYAmt
EOY	$124,282	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$3,900,399	BOYAmt
EOY	$2,867,638	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$1,442,860	BOYAmt
EOY	$1,185,332	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$57,968	BOYAmt
EOY	$36,478	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$1,087,922	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$709,040	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$397,007	BOYAmt
EOY	$378,882	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$139,027,587	BOYAmt
EOY	$162,680,533	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,059,109	BOYAmt
EOY	$855,311	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$145,964,552	BOYAmt
EOY	$168,128,456	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$23,675	BOYAmt
EOY	$43,729	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,180,843	BOYAmt
EOY	$1,621,020	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,204,518	BOYAmt
EOY	$1,664,749	EOYAmt

Field	Value	IRS element (for citing)
Org Does Not Follow FASB117	Yes (X)	OrgDoesNotFollowFASB117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

Field	Value	IRS element (for citing)
BOY	$144,760,034	BOYAmt
EOY	$166,463,707	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$144,760,034	BOYAmt
EOY	$166,463,707	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$145,964,552	BOYAmt
EOY	$168,128,456	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$10,074,206	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$11,629,467	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$130,000	OtherCostOrOtherBasisAmt
Book Value	$130,000	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$692,500	OtherCostOrOtherBasisAmt
Depreciation	$611,147	DepreciationAmt
Book Value	$81,353	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$265,422	OtherCostOrOtherBasisAmt
Depreciation	$97,893	DepreciationAmt
Book Value	$167,529	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$378,882	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
HEALTH CLAIMS PAYABLE; INCURRED BUT NOT REPORTED	$1,294,700
ACCUMULATED ELIGIBILITY CREDITS	$326,320

Field	Value	IRS element (for citing)
Total Liability	$1,621,020	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$31,560,374	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$11,629,467	NetUnrealizedGainsInvstAmt
Revenue Not Reported	$11,629,467	RevenueNotReportedAmt
Revenue Subtotal	$19,930,907	RevenueSubtotalAmt
Investment Expenses Not Incld	$266,787	InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt	$266,787	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$20,197,694	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$9,416,526	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$9,416,526	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$266,787	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$440,175	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$706,962	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$10,123,488	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

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, 2019 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS.

PART XII, LINE 4B - OTHER ADJUSTMENTS:

CHANGE IN BENEFIT OBLIGATION 440,177. ROUNDING -2.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

Field	Value	IRS element (for citing)
Person	BRYAN DONOVAN	PersonNm
Title	UNION TRUSTEE	TitleTxt
Base Compensation Filing Org	$0	BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs	$106,637	CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization	$0	BonusFilingOrganizationAmount
Bonus Related Organizations	$0	BonusRelatedOrganizationsAmt
Other Compensation Filing Org	$0	OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs	$913	OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org	$0	DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs	$34,632	DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org	$0	NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs	$25,737	NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org	$0	TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs	$167,919	TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org	$0	CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs	$0	CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 3	FormAndLineReferenceDesc
Explanation	THE UNION TRUSTEES RECEIVE WAGES FROM RELATED PARTY TEAMSTERS LOCAL UNION 404 FOR THERE POSITION OF UNION OFFICERS. SALARIES ARE DETERMINED BY THE UNION BYLAWS AND APPROVED BY THE UNION EXECUTIVE BOARD.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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, 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Direct Controlling NADirectControllingNACd	Controlled OrganizationControlledOrganizationInd
TEAMSTERS LOCAL UNION 404
115 PROGRESS AVENUE	SPRINGFIELD	MA	01104	041171377	REPRESENTATION OF UNION MEMBERS	MA	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

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (14 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Legal Domicile StateLegalDomicileStateCd	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd
BERKSHIRE CONCRETE CORP
550 CHESHIRE ROAD	PITTSFIELD	MA	01201	MA	C	0
BERKSHIRE TRANS MGT CO
67 DOWNING PARKWAY	PITTSFIELD	MA	01201	MA	C	0
YRC INC
10990 ROE AVE	OVERLAND PARK	KS	66211	KS	C	0
SULLIVAN TRANSPORT INC
PO BOX 90155	SPRINGFIELD	MA	01139	MA	C	0
TITAN ROOFING
165 HARING STREET	WORCESTER	MA	01604	MA	C	0
UNITED PARCEL SERVICE
100 EAST CAMPUS VIEW BLVD	COLUMBUS	OH	43235	OH	C	0
WILLIAMS DISTRUBUTING
PO BOX 98	CHICOPEE	MA	01021	MA	C	0
CONSTRUCTION SERVICE
2420 BOSTON ROAD	WILBRAHAM	MA	01095	MA	C	0
ET & L CONSTRUCTION
873 GREAT ROAD	STOW	MA	01775	MA	C	0
NEW PENN MOTOR EXPRESS
625 S 5TH AVE	LEBANON	PA	17042	PA	C	0
ASHLAND INC
1111 GRATTAN STREET	CHICOPEE	MA	01013	MA	C	0
ARKANSAS BEST FREIGHT
PO BOX 10048	FORT SMITH	AR	72917	AR	C	0
AMERICAN ENVIRONMENTAL GROUP LTD
3600 BRECKSVILLE RD	RICHFIELD	OH	44286	OH	C	0
CASELLA WASTE CO
415 NORTH RD	WESTFIELD	MA	01085	MA	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	0	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (1)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	0	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	0	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	0	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	0	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
TRISTATE JOINT FUND
M	$393,532	CASH VALUE
TEAMSTERS LOCAL UNION 404
J	$52,625	CASH VALUE