2016-02-09T13:33:53-06:00 2015-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2014-07-01 060997832 LOCAL 1035 HEALTH SERVICE AND INSURANCE PLAN LOCA 8605284159 400 CHAPEL STREET UNIT 2-B SOUTH WINDSOR CT 06074 CHRISTOPHER ROOS UNION TRUSTEE 8605284159 2016-02-08 1 DANA HARVEY P01452206 2033877771 2016-02-06 2014 2016-08-17 19:52:53Z CHRISTOPHER ROOS 400 CHAPEL ROAD UNIT 2-B SOUTH WINDSOR CT 06074 21690523 0 X N/A X 1969 CT SELF-INSURED HEALTH BENEFIT PLAN 4 3 3 0 0 0 0 0 8230185 8997285 1336569 1855920 2663 3912 9569417 10857117 0 0 6743962 7420224 208522 219823 0 0 0 487869 473978 7440353 8114025 2129064 2743092 29327946 31601407 895954 971988 28431992 30629419 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 736 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 1 0 1 3 1 0 0 0 0 0 0 X 4 3 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 X CHRISTOPHER ROOS 8605284159 400 CHAPEL STREET UNIT 2-B SOUTH WINDSOR CT 06074 CHRISTOPHER ROOS UNION TRUSTEE 4.00 50.00 X 0 120380 42338 GLENN BARKSDALE UNION TRUSTEE 4.00 4.00 X 2534 2350 0 PAUL NOVAK EMPLOYER TRUSTEE 2.00 X 0 0 0 JAMES STACK EMPLOYER TRUSTEE 2.00 X 0 0 0 2534 122730 42338 0 0 1 0 UBS FINANCIAL SERVICES 333 EARLE OVINGTON BLVD UNIONDALE NY 11553 INVESTMENT MANAGEMENT 150809 1 EMPLOYER CONTRIBUTIONS 900099 8826727 8826727 SPECIAL RETIREE CONTRIBUTIONS 900099 114983 114983 PAYROLL AUDIT CONTRIBUTIONS 900099 55575 55575 8997285 385903 385903 12303423 10833406 1470017 1470017 1470017 CLASS ACTION SETTLEMENT 900099 3912 3912 3912 10857117 9001197 0 1855920 7420224 119920 46289 41708 11906 260520 9384 150809 2400 16739 8422 13028 547 12129 8114025 238472 249352 4840123 9091859 1027633 742365 11082 1709 33546 32548 1545 998 22838292 21319941 370799 195183 29327946 31601407 12872 10333 883082 961655 895954 971988 X 0 0 0 0 28431992 30629419 28431992 30629419 29327946 31601407 2743092 -545665 0 X X 0 1 X 1 0 33546 32548 998 998 HEALTH CLAIMS PAYABLE; INCURRED BUT NOT REPORTED 802300 ACCUMULATED ELIGIBILITY CREDITS 151458 DUE TO AFFILIATE 7897 961655 X 10160642 -545665 -545665 10706307 150809 1 150810 10857117 7892538 0 7892538 150809 70678 221487 8114025 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, 2011 AND PRIOR ARE CLOSED YEARS AND THEREFORE, ARE NOT SUBJECT TO THE AUDIT PROCESS. FORM 990, SCH D, PART XII, LINE 4B CHANGE IN BENEFIT OBLIGATIONS. 0 0 0 CHRISTOPHER ROOS UNION TRUSTEE 0 120380 0 0 0 0 0 0 0 42338 0 162718 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 X11, LINE 2C OVERSIGHT RESPONSIBILITY THERE HAS BEEN NO CHANGE IN THE OVERSIGHT RESPONSIBILITY. THE TRUSTEE'S ASSUME RESPONBILBILITY 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 25 RESEARCH DRIVE MILFORD CT 06460 060850110 3RD PARTY ADMINISTRATOR FOR AFFILIATED ENTITIES CT 501C-9 N/A 0 HARTFORD DISTRIBUTORS 131 CHAPEL ROAD MANCHESTER CT 06040 CT GARELICK FARMS 124 GROVE STREET FRANKLIN MA 02038 MA CANTEENINTERSTATE 155 INDUSTRIAL PARK ROAD MIDDLETOWN CT 06457 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 ALUMINUM RECYCLING 131 CHAPEL ROAD MANCHESTER CT 06040 CT PEPSI COLA BOTTLING CO 55 INTERNATIONAL DRIVE WINDSOR CT 06095 CT TOWN OF TOLLAND TOWN GREEN TOLLAND CT 06084 CT 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 TRISTATE JOINT FUND M 260520