2017-04-25T15:11:25-05:00 2016-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2015-07-01 042174518 TEAMSTERS HEALTH SERVICES & INSURANCE PLAN OF LOCAL UNION 404 TEAM 4137332191 115 PROGRESS AVENUE SPRINGFIELD MA 01104 FRANK A ROSSI UNION TRUSTEE 4137332191 2017-04-25 1 DANA HARVEY CPA P01452206 2033877771 2017-04-25 2015 2021-01-29 14:40:06Z FRANK A ROSSI 115 PROGRESS AVENUE SPRINGFIELD MA 01104 40609323 0 X N/A X 1954 MA SELF-INSURED HEALTH BENEFIT PLAN 4 4 4 0 0 0 0 0 11913427 11751683 4809950 2714103 5407 0 16728784 14465786 0 0 8467315 7897369 400145 399024 0 0 0 779057 1000367 9646517 9296760 7082267 5169026 81249069 81174046 1268281 1061045 79980788 80113001 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 1,337 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 5 0 4 1 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 85667 43866 VICTOR SANTIAGO UNION TRUSTEE 4.00 55.00 X 0 82975 43841 ROBERT SULLIVAN JR EMPLOYER TRUSTEE 2.00 X 0 0 0 LAWRENCE KEEFE EMPLOYER TRUSTEE 2.00 X 0 0 0 0 168642 87707 0 0 0 0 ANTHEM BLUE CROSS BLUE SHIELD 1351 WM HOWARD TAFT RD CINCINNATI OH 45206 REPRICING & ADMIN FEES 217752 1 EMPLOYER CONTRIBUTIONS 900099 11457377 11457377 SPECIAL RETIREE CONTRIBUTIONS 900099 210879 210879 AFFILIATED RENTAL INCOME 900099 46356 46356 COBRA CONTRIBUTIONS 900099 37071 37071 11751683 1982611 1982611 26875029 26143537 731492 731492 731492 14465786 13734294 0 731492 7897369 217615 81690 81963 17756 12002 208062 632089 18469 74861 17426 26491 10967 9296760 173291 201928 3556008 2317576 1137697 1119366 24115 26931 878010 505176 396798 372834 75678787 76736207 282373 399204 81249069 81174046 69263 39659 1199018 1021386 1268281 1061045 X 0 0 0 0 79980788 80113001 79980788 80113001 81249069 81174046 5169026 -5036813 0 X X 0 1 X 1 0 130000 130000 678004 440643 237361 70006 64533 5473 372834 HEALTH CLAIMS PAYABLE; INCURRED BUT NOT REPORTED 818200 ACCUMULATED ELIGIBILITY CREDITS 203186 1021386 X 9245911 -5036813 -5036813 14282724 183062 183062 14465786 9291330 177632 177632 9113698 183062 183062 9296760 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, 2012 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. SCH D PART XII, LINE 4B CHANGE IN BENEFIT OBLIGATION EUROPE (INCLUDING ICELAND & GREENLAND) - INVESTMENTS 1148194 EAST ASIA AND THE PACIFIC - INVESTMENTS 179731 0 0 0 0 0 0 1327925 0 1327925 0 0 0 0 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 11 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 XII, LINE 2C THERE HAS BEEN NO CHANGE IN THE OVERSIGHT RESPONSIBILITY AND APPROVAL PROCESS. THE TRUSTEE'S ASSUME RESPONSIBILITY FOR THE AUDIT PROCESS INCLUDING THE 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 25 RESEARCH DRIVE MILFORD CT 06460 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 LANE CONSTRUCTION CORP 953 ODLIN ROAD BANGOR ME 04401 ME 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 BORGGAARD CONSTRUCTION GROUP 70 CREEPER HILL ROAD NORTH GRAFTON MA 01536 MA C 0 NEW PENN MOTOR EXPRESS 625 S 5TH AVE LEBANON PA 17042 PA C 0 HYDRO CONDUIT CORP 1501 BELVEDERE ROAD WEST PALM BEACH FL 33406 FL 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 COMPLETE DISPOSAL CO 415 NORTH RD WESTFIELD MA 01085 MA TAYLOR OIL NORTHEAST INC 176 CENTRE STREET HOLBROOK MA 02343 MA 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 TEAMSTERS LOCAL UNION 404 J 46356 TRISTATE JOINT FUND M 333760