2023-05-12T08:46:00-05:00 2022-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2021-07-01 060691862 LOCAL 677 HEALTH SERVICE AND INSURANCE PLAN LOCA 2037552906 609 WEST JOHSON AVE CHESHIRE CT 06410 JOHN MURPHY UNION TRUSTEE 2037552906 2023-05-10 1 JOHN MURPHY 999009999 DANA HARVEY CPA P01452206 2033877771 2023-05-10 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JOHN MURPHY 1871 BALDWIN STREET WATERBURY CT 06706 67736295 0 X N/A X 1958 CT SELF-INSURED HEALTH BENEFIT PLAN 4 4 6 0 0 0 0 0 40490368 41390428 5278443 3767192 3242 2145 45772053 45159765 0 0 38826910 48184601 729232 789416 0 0 0 1974093 2173850 41530235 51147867 4241818 -5988102 112858561 95770287 5658113 8657932 107200448 87112355 PROVIDE SELF INSURED HEALTH BENEFITS TO MEMBERS COVERED UNDER A COLLECTIVE BARGAINING AGREEMENT NEGOTIATED BY THE TEAMSTER LOCAL 677 UNION. 0 0 PROVIDES INSURED AND SELF-INSURED MEDICAL, DEATH & LIFEINSURANCE BENEFITS TO 2,953 MEMBERS PLUS THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 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 6 0 1 6 1 0 0 0 0 0 0 0 0 X 4 4 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 EMPLOYER TRUSTEE 2.00 X 0 0 0 HELGA SCHMIDT EMPLOYER TRUSTEE 2.00 X 3500 0 0 JOHN CAPOBIANCO (FORMER) UNION TRUSTEE 2.00 50.00 X 0 143967 67432 MICHAEL RINALDI UNION TRUSTEE 4.00 50.00 X 4200 115802 64774 JOHN MURPHY UNION TRUSTEE 4.00 20.00 X 0 0 0 7700 259769 132206 0 0 1 0 ANTHEM BLUE CROSS BLUE SHIELD 1351 WM HOWARD TAFT RD CINCINNATI OH 45206 REPRICING & ADMIN FEES 702591 MED CARE MANAGEMENT CORP 2090 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33409 BENEFITS CONSULTING 126575 2 EMPLOYER CONTRIBUTIONS 900099 40738704 40738704 SPECIAL RETIREE CONTRIBUTIONS 900099 418783 418783 COBRA CONTRIBUTIONS 900099 152601 152601 PAYROLL AUDIT CONTRIBUTIONS 900099 80340 80340 41390428 1865530 1865530 24478192 22576530 1901662 1901662 1901662 REFUNDS & REIMBURSEMENTS 900099 2145 2145 2145 45159765 41392573 0 3767192 X 48184601 18900 427132 147436 160748 35200 7984 128700 1872307 63377 702 46108 26837 1021 2266 24548 51147867 424690 368680 5543995 4552663 3345344 3636259 19063 2918 36003 11103 25582 24900 97225654 86931028 3412699 2861534 253839 112858561 95770287 56512 89337 5601601 8568595 5658113 8657932 X 0 0 0 0 107200448 87112355 107200448 87112355 112858561 95770287 -5988102 -14099991 0 X X 0 1 X 1 0 3605 361 3244 32398 10742 21656 24900 HEALTH CLAIMS PAYABLE; INCURRED BUT NOT REPORTED 5735400 ACCUMULATED ELIGIBILITY CREDITS 799968 HEALTH BENEFITS EXPERIANCE RECONCILIATION 699156 DUE TO AFFILIATE 1334071 8568595 X 30931074 -14099991 -14099991 45031065 128700 128700 45159765 49358776 0 49358776 128700 1660391 1789091 51147867 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, 2018 AND PRIOR ARE CLOSED YEARS AND ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: ROUNDING ADJUSTMENT PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION 1,660,390. ROUNDING ADJUSTMENT 1. 0 0 0 JOHN CAPOBIANCO (FORMER) UNION TRUSTEE 0 138504 0 0 0 5463 0 42260 0 25172 0 211399 0 0 MICHAEL RINALDI UNION TRUSTEE 4200 113220 0 0 0 2582 0 42017 0 22757 4200 180576 0 0 PART I, LINE 3 AMOUNTS PAID TO UNION TRUSTEES BY RELATED PARTY TEAMSTERS LOCAL 677 ARE DETERMINED BY THE UNION BYLAWS AND APPROVED BY THE LOCAL UNION EXECUTIVE BOARD. 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 IX, LINE 11G CLAIM ADMINISTRATION 1,014,720. REPRICING & ADMIN FEES 734,337. MEDICAL REVIEW 123,250. 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. 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