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 042174518 TEAMSTERS HEALTH SERVICES & INSURANCE PLAN OF LOCAL UNION 404 TEAM 4137332191 115 PROGRESS AVENUE SPRINGFIELD MA 01104 FRANK A ROSSI UNION TRUSTEE 4137332191 2021-05-04 1 DANA HARVEY CPA P01452206 2033877771 2021-05-04 2019 2022-09-23 18:48:47Z FRANK A ROSSI 115 PROGRESS AVENUE SPRINGFIELD MA 01104 41392019 0 X N/A X 1954 MA SELF-INSURED HEALTH BENEFIT PLAN 4 4 4 0 0 0 0 0 13615865 14261343 4758618 3354368 5574 590 18380057 17616301 0 0 8618504 7730745 435506 452810 0 0 0 1079147 1108609 10133157 9292164 8246900 8324137 116104733 118890524 1593961 1037428 114510772 117853096 PROVIDE SELF INSURED HEALTH BENEFITS TO MEMBERS COVERED UNDER A COLLECTIVE BARGAINING AGREEMENT NEGOTIATED BY THE TEAMSTERS LOCAL 404 UNION. 0 0 PROVIDES INSURED AND SELF-INSURED MEDICAL, DEATH & LIFEINSURANCE BENEFITS TO 1,1400 MEMBERS PLUS THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 4 0 1 4 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 FRANK A ROSSI 4137332191 115 PROGRESS AVENUE SPRINGFIELD MA 01104 FRANK ROSSI UNION TRUSTEE 4.00 55.00 X 0 104823 51493 VICTOR SANTIAGO UNION TRUSTEE 4.00 55.00 X 0 103145 51475 ROBERT SULLIVAN JR EMPLOYER TRUSTEE 2.00 X 0 0 0 LAWRENCE KEEFE EMPLOYER TRUSTEE 2.00 X 0 0 0 0 207968 102968 0 0 1 0 ANTHEM BLUE CROSS BLUE SHIELD 1351 WM HOWARD TAFT RD CINCINNATI OH 45206 REPRICING & ADMIN FEES 234273 1 EMPLOYER CONTRIBUTIONS 900099 13967488 13967488 SPECIAL RETIREE CONTRIBUTIONS 900099 217352 217352 AFFILIATED RENTAL INCOME 900099 48674 48674 COBRA CONTRIBUTIONS 900099 27829 27829 14261343 2639228 2639228 24490858 23775670 48 715188 -48 715140 -48 715188 REFUNDS & REIMBURSMENTS 900099 590 590 590 17616301 14261885 0 3354416 7730745 222980 118064 93403 18363 1947 259432 665146 13421 99371 10230 1995 30822 26245 9292164 112426 80573 2055667 4013946 1132247 1387489 27714 68006 1066252 607788 334814 458464 111979165 111822258 462700 1059788 116104733 118890524 60905 61971 1533056 975457 1593961 1037428 X 0 0 0 0 114510772 117853096 114510772 117853096 116104733 118890524 8324137 -4981813 0 X X 0 1 X 1 0 130000 130000 677668 537562 140106 258584 70226 188358 458464 HEALTH CLAIMS PAYABLE; INCURRED BUT NOT REPORTED 736100 ACCUMULATED ELIGIBILITY CREDITS 239357 975457 X 12400103 -4981813 -4981813 17381916 234432 -47 234385 17616301 9087093 0 9087093 234432 -29361 205071 9292164 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, 2016 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF ASSETS -48. ROUNDING ADJUSTMENT 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATION -29,313. LOSS ON DISPOSAL OF ASSETS -48. ROUNDING ADJUSTMENT EUROPE (INCLUDING ICELAND & GREENLAND) - 0 0 INVESTMENTS 1322270 EAST ASIA AND THE PACIFIC - AUSTRALIA, BRUNEI, BURMA, CAMBODIA, 0 0 INVESTMENTS 281562 NORTH AMERICA 0 0 INVESTMENTS 179393 0 0 0 0 0 0 1783225 0 1783225 0 0 0 0 0 0 PART I, LINE 3: QUOTED EXCHANGE FMV PART III ACCOUNTING METHOD: 0 0 0 FRANK ROSSI UNION TRUSTEE 0 102529 0 0 0 2294 0 28228 0 23265 0 156316 0 0 VICTOR SANTIAGO UNION TRUSTEE 0 99929 0 0 0 3216 0 28228 0 23247 0 154620 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. 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 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 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 TRISTATE JOINT FUND M 347320 FMV