2024-05-14T11:03:04-05:00 2023-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2022-07-01 060850110 TRI-STATE JOINT FUND TRI- 2032502601 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 BEVAN SWEET UNION CO-CHAIRMAN 2032502601 2024-05-14 1 BEVAN SWEET 999009999 0 DANA HARVEY CPA P01452206 2033877771 2024-05-14 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BEVAN SWEET 609 WEST JOHNSON AVENUE 2ND FL CHESHIRE CT 06410 141074542 0 X N/A X 1968 CT SELF-INSURED HEALTH BENEFIT PLAN 23 23 11 0 0 0 0 0 121373559 125171732 427479 -953275 1360 35770 121802398 124254227 0 0 118264355 121338642 1433393 1484970 0 0 0 1995181 2503759 121692929 125327371 109469 -1073144 32402096 32248972 12283855 11145732 20118241 21103240 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 11,499 ACTIVE AND RETIRED 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 1 151 0 1 11 1 0 0 0 0 0 0 0 0 X 23 23 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 20000 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 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 GEORGE WIESENDANGER EMPLOYER TRUSTEE 1.00 4.00 X 0 0 0 FRANK ROSSI UNION TRUSTEE 1.00 4.00 X 0 0 0 BRYAN DONOVAN JR 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 CO-CHAIRMAN 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 SCOTT BLAIS EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 ANTHONY LEPORE UNION TRUSTEE 1.00 4.00 X 0 0 0 MICHAEL RINALDI (FORMER) UNION TRUSTEE 1.00 4.00 X 0 0 0 HELGA SCHMIDT (FORMER) EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 PAUL AYOUB EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 GLENN BARKSDALE UNION TRUSTEE 1.00 4.00 X 0 0 0 PAUL NOVAK (FORMER) EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 JAMES STACK EMPLOYER TRUSTEE 1.00 2.00 X 0 0 0 ROBERT ZIOBROWSKI UNION TRUSTEE 1.00 4.00 X 0 0 0 ARTHUR BELL UNION TRUSTEE 1.00 4.00 X 0 0 0 SHARON AGNELLO EXECUTIVE DIRECTOR 40.00 X 153813 0 50553 SUSAN KOSTEK IT DIRECTOR 40.00 X 116089 0 50553 ERIN FLAVIN CLAIMS ADMINISTRATOR 40.00 X 114248 0 50553 404150 0 151659 3 0 1 0 THE SEGAL COMPANY CHURCH STREET STATION P O BOX 4059 NEW YORK NY 102614059 ACTUARIAL 412889 SOFTWARE SYSTEM SOLUTIONS LLC 270 FRAMINGTON AVE FARMINGTON CT 06032 COMPUTER & TECHNOLOGY SUPPORT 338308 ROBERT M CHEVERIE & ASSOC 333 EAST RIVER DRIVE EAST HARTFORD CT 06108 LEGAL 322230 SM ESPOSITO & COMPANY PC 3013 DIXWELL AVE HAMDEN CT 06518 ACCOUNTING/AUDITING 305747 CHANGE HEALTHCARE PAYMENT MGMT 3055 LEBANON PIKE NASHVILLE TN 37214 PRINTING/MAILING 155777 5 CONTRIBUTIONS - HEALTH FUNDS 900099 125170162 125170162 RENTAL INCOME - AFFILIATE 900099 1570 1570 125171732 449159 449159 15386381 31500 16796232 24083 -1409851 7417 -1402434 7417 -1409851 REFUNDS & REIMBURSEMENTS 900099 35770 35770 35770 124254227 125214919 0 -960692 121338642 186040 711532 241511 275868 70019 322230 197747 48644 532189 375881 465391 172542 34553 118639 23353 52377 OUTSIDE SERVICES - PAYM 155777 MEDICAL EQUIPMENT 4436 125327371 97532 161953 3384101 2371837 50784 80785 494381 392309 139724 102072 18146779 19369335 10583176 10162990 32402096 32248972 1521288 1565690 10762567 9580042 12283855 11145732 X 0 0 0 0 20118241 21103240 20118241 21103240 32402096 32248972 -1073144 2058143 0 X X 0 1 X 1 0 10148 3046 7102 122110 72576 49534 362123 316687 45436 102072 MISCELLANEOUS RECEIVABLE 3060282 DUE FROM AFFILIATES 6293260 SECURITY DEPOSIT 7583 RIGHT OF USE ASSET - OPERATING LEASES 801865 10162990 DUE TO ANTHEM 2985328 DUE TO AFFILIATES 4966764 CLAIMS INCURRED BUT NOT RECEIVED 47500 HEALTH BENEFITS RECONCILIATION 764560 RIGHT OF USE LIABILITY - OPERATING LEASES 815890 9580042 X 126312369 2058143 2058143 124254226 1 1 124254227 125307672 0 125307672 19699 19699 125327371 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 XI, LINE 4B - OTHER ADJUSTMENTS: ROUNDING ADJUSTMENT 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION 19,700. ROUNDING ADJUSTMENT -1. X 0 0 0 SHARON AGNELLO EXECUTIVE DIRECTOR 153813 0 0 0 0 0 24684 0 25869 0 204366 0 0 0 SUSAN KOSTEK IT DIRECTOR 116089 0 0 0 0 0 24684 0 25869 0 166642 0 0 0 ERIN FLAVIN CLAIMS ADMINISTRATOR 114248 0 0 0 0 0 24684 0 25869 0 164801 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 (FORMER) CO-CHAIR JOHN CAPOBIANCO 129582 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 939951 CASH VALUE TEAMSTERS LOCAL 404 HEALTH SERVICE & INSURANCE PLAN L 393532 CASH VALUE TRANSPORTATION LOCAL 443 HEALTH SERVICE & INSURANCE PLAN L 730408 CASH VALUE GENERAL TEAMSTERS LOCAL 493 HEALTH SERVICE & INSURANCE PLAN L 337741 CASH VALUE TEAMSTERS LOCAL 671A HEALTH SERVICE & INSURANCE PLAN L 213670 CASH VALUE TEAMSTERS LOCAL 677 HEALTH SERVICE & INSURANCE PLAN L 519675 CASH VALUE TEAMSTERS LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN L 344722 CASH VALUE