2021-05-14T07:40:27-05:00 2020-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2019-07-01 060997832 LOCAL 1035 HEALTH SERVICE AND INSURANCE PLAN LOCA 8605284159 400 CHAPEL STREET UNIT 2-B SOUTH WINDSOR CT 06074 ROBERT ZIOBROWSKI UNION TRUSTEE 8605284159 2021-05-10 1 DANA HARVEY P01452206 2033877771 2021-05-10 2019 2022-09-23 18:48:47Z ROBERT ZIOBROWSKI 400 CHAPEL ROAD UNIT 2-B SOUTH WINDSOR CT 06074 19014838 0 X N/A X 1969 CT SELF-INSURED HEALTH BENEFIT PLAN 4 4 5 0 0 0 0 0 8917944 8856274 1650897 2279557 1052 3145 10569893 11138976 0 0 8789541 9767928 380702 375001 0 0 0 772820 730393 9943063 10873322 626830 265654 41565060 41600314 1786281 1291134 39778779 40309180 PROVIDE SELF INSURED HEALTH BENEFITS TO MEMBERS COVERED UNDER A COLLECTIVE BARGAINING AGREEMENT NEGOTIATED BY THE TEAMSTER LOCAL 1035 UNION. 0 0 PROVIDES INSURED AND SELF-INSURED MEDICAL, DEATH & LIFEINSURANCE BENEFITS TO 763 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 3 0 1 5 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 ROBERT ZIOBROWSKI 8605284159 400 CHAPEL STREET UNIT 2-B SOUTH WINDSOR CT 06074 CHRISTOPHER ROOS (FORMER) UNION TRUSTEE 4.00 50.00 X 0 92261 35823 GLENN BARKSDALE UNION TRUSTEE 4.00 4.00 X 3609 0 0 PAUL NOVAK EMPLOYER TRUSTEE 2.00 X 0 0 0 JAMES STACK EMPLOYER TRUSTEE 2.00 X 0 0 0 ROBERT ZIOBROWSKI UNION TRUSTEE 4.00 50.00 X 0 102900 39504 3609 195161 75327 0 0 0 0 ANTHEM BLUE CROSS BLUE SHIELD 1351 WM HOWARD TAFT RD CINCINNATI OH 45206 REPRICING & ADMIN FEES 175353 UBS FINANCIAL SERVICES 333 EARLE OVINGTON BLVD UNIONDALE NY 11553 INVESTMENT MANAGEMENT 146503 2 EMPLOYER CONTRIBUTIONS 900099 8749902 8749902 SPECIAL RETIREE CONTRIBUTIONS 900099 83280 83280 PAYROLL AUDIT CONTRIBUTIONS 900099 15141 15141 COBRA CONTRIBUTIONS 900099 7951 7951 8856274 695486 695486 9459933 7875862 1584071 1584071 1584071 REFUNDS & REIMBURSEMENTS 900099 3145 3145 3145 11138976 8859419 0 2279557 9767928 200248 81392 76729 16632 846 146503 521757 19538 7380 5234 5460 351 23324 10873322 129357 154995 6743682 5281970 498746 643480 22266 6521 28810 27618 346 1192 34150696 35109648 19967 402508 41565060 41600314 19970 15950 1766311 1275184 1786281 1291134 X 0 0 0 0 39778779 40309180 39778779 40309180 41565060 41600314 265654 264747 0 X X 0 1 X 1 0 2351 1159 1192 26459 26459 0 1192 HEALTH CLAIMS PAYABLE; INCURRED BUT NOT REPORTED 929300 ACCUMULATED ELIGIBILITY CREDITS 181116 DUE TO PARTICIPATING HEALTH SERVICE 164768 1275184 X 11257220 264747 264747 10992473 146503 146503 11138976 10607286 0 10607286 146503 119533 266036 10873322 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 ORGANIZATION FILES ITS FORM 990 IN THE U.S. FEDERAL JURISDICTION. THE PLAN BELIEVES THAT THE INCOME TAX RETURNS FOR YEARS ENDED JUNE 30, 2016 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION 119,533. 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. IBT LOCAL UNION 1035 400 CHAPEL ROAD UNIT 2-B SOUTH WINDSOR CT 06074 060915620 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 HARTFORD DISTRIBUTORS 131 CHAPEL ROAD MANCHESTER CT 06040 CT COCA-COLA OF NEW ENGLAND 451 MAIN STREET EAST HARTFORD CT 06108 CT ROGO DISTRIBUTORS 65 ROBERTS STREET EAST HARTFORD CT 06108 CT DEAN FOODS 3600 RIVER ROAD FRANKLIN IL 61031 IL TOWN OF TOLLAND TOWN GREEN TOLLAND CT 06084 CT 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 TRISTATE JOINT FUND M 261560 CASH VALUE