2013-02-07T14:52:43-06:00 2012-06-30 061298465 SM ESPOSITO & CO PC 3013 DIXWELL AVENUE HAMDEN CT 06518 990 2011-07-01 060850110 TRI-STATE JOINT FUND TRI- 2038763110 25 RESEARCH DRIVE MILFORD CT 06460 DENNIS E RAYMOND 2038763103 2013-02-07 1 2033877771 2013-02-07 2011 2016-02-25 16:41:14Z DENNIS E RAYMOND 25 RESEARCH DRIVE MILFORD CT 06460 82044323 0 X N/A X 1968 CT SELF-INSURED HEALTH BENEFIT PLAN 28 28 16 0 0 0 0 0 77241528 78773261 417179 322885 30181 2306 77688888 79098452 0 0 75123997 76463341 1362300 1320581 0 0 0 1605556 1603308 78091853 79387230 -402965 -288778 16206546 14997874 3595688 2943996 12610858 12053878 PROVIDE SELF-INSURED HEALTH AND WELFARE BENEFITS TO MEMBERS COVERED UNDER COLLECTIVE BARGAINING AGREEMENTS NEGOTIATED BY TEAMSTER LOCALS. 0 0 79387230 THE FUND OPERATES UNDER A TRUST AGREEMENT FOR THE PURPOSEOF MAKING BENEFIT PAYMENTS TO MEMBERS OF THE TRI-STATETEAMSTERS HEALTH SERVICES & INSURANCE PLAN, THESE BENEFITS COVER HOSPITAL,SURGICAL, PRESCRIPTION DRUG, HOME HEALTH CARE AND DEATH BENEFITS FOR 11,281 MEMBERS PLUS THEIR DEPENDENTS. 79387230 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 0 1 15 0 1 16 1 0 0 0 0 0 0 0 0 X 28 28 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 0 1 0 X PATRICIA SANDILLO 2038763103 25 RESEARCH DRIVE MILFORD CT 06460 DENNIS RAYMOND 4.00 X 0 0 0 JOSEPH ESPOSITO 1.00 X 0 0 0 EDWIN ROONEY 1.00 X 0 0 0 ANTHONY CAPPELLA 1.00 X 0 0 0 RAYMOND ONEGLIA 1.00 X 0 0 0 FRANK ROSSI 1.00 X 0 0 0 VICTOR SANTIAGO 1.00 X 0 0 0 ROBERT SULLIVAN JR 1.00 X 0 0 0 SCOTT THOMSON 1.00 X 0 0 0 ROBERT BAYUSIK 1.00 X 0 0 0 LINDA BUNNELL 1.00 X 0 0 0 DENNIS MCGUIRE 4.00 X 0 0 0 THOMAS SCHLINK 1.00 X 0 0 0 BEVAN SWEET 1.00 X 0 0 0 NICHOLAS REUT 1.00 X 0 0 0 BLAIR HEAGY 1.00 X 0 0 0 THOMAS GILMARTIN 1.00 X 0 0 0 ROY SULLIVAN 1.00 X 0 0 0 TIMOTHY MCAVOY 1.00 X 0 0 0 JOHN LEAHY 1.00 X 0 0 0 GEORGE BRIER 1.00 X 0 0 0 ALAN FREOHLICH 1.00 X 0 0 0 CHRISTOPHER ROOS 1.00 X 0 0 0 GLENN BARKSDALE 1.00 X 0 0 0 PAUL NOVAK 1.00 X 0 0 0 JAMES STACK 1.00 X 0 0 0 TIMOTHY CASEY 1.00 X 0 0 0 HELGA SCHMIDT 1.00 X 0 0 0 PATRICIA SANDILLO 40.00 X X 132328 0 36700 RONALD DEFILIPPO 1.00 X 0 0 0 KENNETH PAUZE 1.00 X 0 0 0 JOHN CAPOBIANCO 1.00 X 0 0 0 132328 0 36700 1 0 1 0 ROBERT M CHEVERIE & ASSOC 333 EAST RIVER DRIVE EAST HARTFORD CT 06108 LEGAL 305989 THE SEGAL COMPANY CHURCH STREET STATION P O BOX 4059 NEW YORK NY 102614059 ACTUARIAL 238188 EMDEONABF 3183 RIDER TRAIL SOUTH EARTH CITY MO 63045 PRINTING/MAILING 127426 3 CONTRIBUTIONS - HEALTH 900099 78773261 78773261 78773261 166861 166861 3101895 2945871 156024 156024 156024 RENTAL INCOME 900099 1500 1500 SECURITY LITIGATION PR 900099 806 806 2306 79098452 79098452 0 0 76463341 76463341 768236 768236 241706 241706 244643 244643 65996 65996 352136 352136 113500 113500 48088 48088 38025 38025 467278 467278 62480 62480 61622 61622 49288 49288 CONSULTING FEE (ACTUARI 245471 245471 OUTSIDE SERVICES 101099 101099 PROPERTY TAXES 35482 35482 UTILITIES 28839 28839 79387230 79387230 0 0 3659613 5576991 80158 86428 4860367 4352534 560421 507833 9490601 7479634 2415753 1346988 16206546 14997874 837098 783148 2758590 2160848 3595688 2943996 X 0 0 0 0 12610858 12053878 12610858 12053878 16206546 14997874 X -288778 -268202 X 0 1 1 X 0 152788 152788 3652520 3416908 235612 1055059 935626 119433 507833 INTEREST RECEIVABLE 26241 MISCELLANEOUS RECEIVABLE 691842 DUE FROM AFFILIATES - CONTRIBUTIONS 628905 1346988 DUE TO ANTHEM 1742760 DUE TO AFFILIATES 123039 HEALTH BENEFIT RECONCILIATION 295049 2160848 79098452 79387230 -288778 -268202 -268202 -556980 78830250 -268202 -268202 79098452 0 79098452 79387230 0 79387230 0 79387230 0 0 0 PATRICIA SANDILLO 122570 0 9758 0 0 0 0 0 36700 0 169028 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED IN PERSON WITH THE CO-CHAIRMEN AND THE EXECUTIVE DIRECTOR PRIOR TO FILING OF THE RETURN. FORM 990, PART VI, SECTION B, LINE 15B THE CO-CHAIRMEN REVIEW AND ADJUST THE COMPENSATION OF THE EXECUTIVE DIRECTOR ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 TRI-STATE JOINT FUND DOES NOT MAKE AVAILABLE TO THE GENERAL PUBLICANY OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -268,202. IBT TEAMSTERS LOCAL 191 HEALTH SERVICE & INSURANCE PLAN 1139 FAIRFIELD AVENUE BRIDGEPORT CT 06605 060689974 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 404 HEALTH SERVICE & INSURANCE PLAN 115 PROGRESS AVENUE SPRINGFIELD MA 01104 042174518 AFFILIATED SELF INSURED HEALTH PLAN MA 501C-9 N/A 0 TRANSPORTATION LOCAL 443 HEALTH SERVICE & INSURANCE PLAN 200 WALLACE STREET NEW HAVEN CT 06511 060690083 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 GENERAL TEAMSTERS LOCAL 493 HEALTH SERVICE & INSURANCE PLAN 18 CRESENT STREET UNCASVILLE CT 06382 060689500 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 559 HEALTH SERVICE & INSURANCE PLAN 400 CHAPEL ROAD UNIT 2-B SOUTH WINDSOR CT 06074 060683663 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 677 HEALTH SERVICE & INSURANCE PLAN 1871 BALDWIN STREET WATERBURY CT 06706 060691862 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 TEAMSTERS LOCAL 1035 HEALTH SERVICE & INSURANCE PLAN 400 CHAPEL ROAD UNIT 2-A SOUTH WINDSOR CT 06074 060997832 AFFILIATED SELF INSURED HEALTH PLAN CT 501C-9 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0