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 060691862 LOCAL 677 HEALTH SERVICE AND INSURANCE PLAN LOCA 2037552906 1871 BALDWIN STREET WATERBURY CT 06706 JOHN CAPOBIANCO UNION TRUSTEE 2037552906 2021-05-06 1 DANA HARVEY CPA P01452206 2033877771 2021-05-06 2019 2022-09-23 18:48:47Z JOHN CAPOBIANCO 1871 BALDWIN STREET WATERBURY CT 06706 107874235 0 X N/A X 1958 CT SELF-INSURED HEALTH BENEFIT PLAN 4 4 7 0 0 0 0 0 36231544 37729103 3018230 9299143 0 298 39249774 47028544 0 0 34041989 31477033 672305 692377 0 0 0 2246199 2201911 36960493 34371321 2289281 12657223 87794025 94119719 5091810 3912940 82702215 90206779 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 2,858 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 2 0 1 7 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 CAPOBIANCO 2037552906 1871 BALDWIN STREET WATERBURY CT 06706 PAUL AYOUB EMPLOYER TRUSTEE 2.00 X 0 0 0 HELGA SCHMIDT EMPLOYER TRUSTEE 2.00 X 0 0 0 JOHN CAPOBIANCO UNION TRUSTEE 2.00 50.00 X 0 137836 65998 MICHAEL RINALDI UNION TRUSTEE 4.00 50.00 X 0 115258 65521 0 253094 131519 0 0 1 0 ANTHEM BLUE CROSS BLUE SHIELD 1351 WM HOWARD TAFT RD CINCINNATI OH 45206 REPRICING & ADMIN FEES 647565 MED CARE MANAGEMENT CORP 2090 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33409 BENEFITS CONSULTING 123646 PREFERRED ACCESS NETWORK 1510 WEST 75TH STREET DARIEN IL 60561 REPRICING FEES 112490 3 EMPLOYER CONTRIBUTIONS 900099 37353473 37353473 SPECIAL RETIREE CONTRIBUTIONS 900099 312118 312118 COBRA CONTRIBUTIONS 900099 63512 63512 37729103 1608159 1608159 68536675 60845691 7690984 7690984 7690984 REFUNDS & REIMBURSEMENTS 900099 298 298 298 47028544 37729401 0 9299143 31477033 377179 146522 139963 28713 2926 144633 1936372 44342 41666 8818 1995 1198 19961 34371321 190097 233732 6897219 11683426 3090628 3098063 20466 6083 32398 6797 6245 25601 70907705 72782314 3139807 4513768 3541858 1776732 87794025 94119719 47965 46321 5043845 3866619 5091810 3912940 X 0 0 0 0 82702215 90206779 82702215 90206779 87794025 94119719 12657223 -5152659 0 X X 0 1 X 1 0 32398 6797 25601 25601 HEALTH CLAIMS PAYABLE; INCURRED BUT NOT REPORTED 3179800 ACCUMULATED ELIGIBILITY CREDITS 686819 3866619 X 41731251 -5152659 -5152659 46883910 144633 1 144634 47028544 34915892 0 34915892 144633 -689204 -544571 34371321 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, 2016 AND PRIOR ARE CLOSED YEARS AND 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 -689,205. ROUNDING ADJUSTMENT 1. 0 0 0 JOHN CAPOBIANCO UNION TRUSTEE 0 134000 0 0 0 3836 0 42598 0 23400 0 203834 0 0 MICHAEL RINALDI UNION TRUSTEE 0 112560 0 0 0 2698 0 42598 0 22923 0 180779 0 0 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. 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