2024-03-12T12:57:11-05:00 2023-08-31 611436956 NOVAK FRANCELLA LLC 40 MONUMENT RD 5TH FLR BALA CYNWYD PA 19004 990 2022-09-01 042226511 TEAMSTERS UNION LOCAL 25 HEALTH SERVICES & INSURANCE PLAN TEAM 6172419220 529 MAIN STREET 209 CHARLESTOWN MA 02129 THOMAS G MARI UNION TRUSTEE CO-CHAIRMAN 6172419220 2024-03-12 1 THOMAS MARI 999009999 0 LOUIS VERZELLA CPA P00360279 6106689400 2024-03-12 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z THOMAS G MARI 529 MAIN STREET 209 CHARLESTOWN MA 02129 276131206 0 X WWW.TEAMSTERSCARE.COM X 1955 MA THE PLAN PROVIDES MEDICAL, HOSPITALIZATION, DENTAL, VISION, HEARING, LIFE INSURANCE, COUNSELING, WEEKLY DISABILITY, AND PRESCRIPTION DRUG BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. THE PLAN ALSO PROVIDES A PROGRAM OF BENEFITS FOR ELIGIBLE RETIREES. 8 4 73 0 0 0 0 0 180677066 185860312 25448067 11956521 315038 1869759 206440171 199686592 0 0 145603380 152108206 8539096 8803902 0 0 0 2512657 2889121 156655133 163801229 49785038 35885363 308767057 354814661 818727 4253591 307948330 350561070 THE PLAN PROVIDES MEDICAL, HOSPITALIZATION, DENTAL, VISION, HEARING, LIFE INSURANCE, COUNSELING, WEEKLY DISABILITY, AND PRESCRIPTION DRUG BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. THE PLAN ALSO PROVIDES A PROGRAM OF BENEFITS FOR ELIGIBLE RETIREES. 0 0 PLAN PROVIDES MEDICAL, HOSPITAL, DENTAL, PRESCRIPTION, DISABILITY, MENTAL HEALTH, AUDIOLOGY, WELLNESS, AND LIFE AND ACCIDENTAL DEATH INSURANCE BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 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 31 0 73 1 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X MARIA GNERRE 6172419220 529 MAIN STREET SUITE 209 CHARLESTOWN MA 02129 THOMAS G MARI UNION TRUSTEE, CO-CHAIRMAN 2.00 45.00 X 0 184662 51752 MICHAEL SHAUGHNESSY EMPLOYER TRUSTEE, CO-CHAIR 2.00 X 0 0 0 STEVEN J SOUTH UNION TRUSTEE 2.00 45.00 X 0 174469 51752 JASON LOPES UNION TRUSTEE 2.00 45.00 X 0 137510 51752 ANDREW P WALSH UNION TRUSTEE 2.00 45.00 X 0 138545 51752 JASON PARADIS EMPLOYER TRUSTEE 2.00 X 0 0 0 JOHN WHITE EMPLOYER TRUSTEE 2.00 X 0 0 0 MATTHEW LOUGHLIN EMPLOYER TRUSTEE 2.00 X 0 0 0 CAROL A BLANCHARD DDS EXECUTIVE DIRECTOR (P) 40.00 X 276637 0 50566 MARIA GNERRE EXECUTIVE DIRECTOR 40.00 X 64206 0 53256 LAURIE MURPHY DENTAL DIRECTOR 40.00 X 159200 0 50575 MARK C ANTIDORMI PHARMACY DIRECTOR 40.00 X 158352 0 53708 ANISSA DERROUCHE DENTAL MANAGER 40.00 X 160404 0 53708 JOANNE SCHULTZ DENTIST 40.00 X 148856 0 53708 AZITA NEGAHBAN DENTIST 40.00 X 152391 0 53708 1120046 635186 576237 20 0 1 0 BLUECROSS BLUESHIELD OF MASSACHUSETTS 25 TECHNOLOGY PLACE HINGHAM MA 02013 CLAIMS ADMINISTRATION 271348 EXPRESS SCRIPTSMEDCO N19 W24130 RIVERWOOD DR WAUKESHA WI 53188 CLAIMS ADMINISTRATION 185141 FEINBERG DUMONT & BRENNAN 177 MILK STREET STE 300 BOSTON MA 02109 ATTORNEYS 156276 MANZI & ASSOCIATES LLC 1855 TURNPIKE STREET NORTH ANDOVER MA 01845 PAYROLL AUDITORS/ACCOUNTING 148429 BMO HARRIS BANK 7501 WEST NORTH AVE WAUWATOSA WI 53213 CUSTODIAL AND INVESTMENT MGT 143546 10 EMPLOYER CONTRIBUTION 525100 169084256 169084256 REIMBURSEMENTS AND CO-PAYS 525100 9818252 9818252 PARTICIPANT CONTRIBUTION 525100 6957804 6957804 185860312 5655572 5655572 82745563 76444614 6300949 6300949 6300949 OTHER INCOME 900099 1632105 1632105 REPAYMENT OF CLAIMS 900099 237654 237654 1869759 199686592 186097966 0 13588626 152108206 253606 4969454 1423029 1696704 461109 156276 220224 605272 11997 212782 271715 873178 10794 198435 285368 FEES MANDATED BY THE AC 43080 163801229 68695 2335 28669860 31635659 16260777 17418781 229293 246905 2651247 1559780 1285734 1091467 86207945 118159996 174954428 181425218 3592772 1090325 1241528 308767057 354814661 522163 263764 296564 3989827 818727 4253591 X 0 0 0 0 307948330 350561070 307948330 350561070 308767057 354814661 35885363 6727377 0 X X 0 1 X 1 0 1454392 635100 819292 228156 176233 51923 968699 748447 220252 1091467 REAL ESTATE INVESTMENT TRUST 14679103 F COMMON COLLECTIVE TRUST FUNDS 110738254 F LIMITED PARTNERSHIP - SECURED FLOATING RATE LOAN FUND 15226687 F COMMINGLED FUND 12815888 F LIMITED PARTNERSHIP - EMERGING MARKETS 10324597 F LIMITED PARTNERSHIP - INT'L EQUITY 17640689 F 181425218 DEFERRED COMPENSATION PLAN 338511 OPERATING LEASE LIABILITY 3651316 3989827 X 205808697 6727377 6727377 199081320 605272 605272 199686592 163195957 0 163195957 605272 605272 163801229 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT, MORE LIKELY THAN NOT, WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE U.S. FEDERAL, STATE, OR LOCAL TAXING AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. TYPICALLY, PLAN TAX YEARS WILL REMAIN OPEN FOR THREE YEARS, HOWEVER THIS MAY DIFFER DEPENDING UPON THE CIRCUMSTANCES OF THE PLAN. X 0 0 0 CAROL A BLANCHARD DDS EXECUTIVE DIRECTOR (P) 276637 0 0 0 0 0 23280 0 27286 0 327203 0 0 0 THOMAS G MARI UNION TRUSTEE, CO-CHAIRMAN 0 184662 0 0 0 0 0 24689 0 27063 0 236414 0 0 STEVEN J SOUTH UNION TRUSTEE 0 174469 0 0 0 0 0 24689 0 27063 0 226221 0 0 ANISSA DERROUCHE DENTAL MANAGER 160404 0 0 0 0 0 24690 0 29018 0 214112 0 0 0 MARK C ANTIDORMI PHARMACY DIRECTOR 158352 0 0 0 0 0 24690 0 29018 0 212060 0 0 0 LAURIE MURPHY DENTAL DIRECTOR 159200 0 0 0 0 0 23247 0 27328 0 209775 0 0 0 AZITA NEGAHBAN DENTIST 152391 0 0 0 0 0 24690 0 29018 0 206099 0 0 0 JOANNE SCHULTZ DENTIST 148856 0 0 0 0 0 24690 0 29018 0 202564 0 0 0 ANDREW P WALSH UNION TRUSTEE 0 138545 0 0 0 0 0 24689 0 27063 0 190297 0 0 JASON LOPES UNION TRUSTEE 0 137510 0 0 0 0 0 24689 0 27063 0 189262 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S AUDITOR PREPARES THE FORM 990 AND REVIEWS IT WITH MANAGEMENT AND THE GOVERNING BODY'S CO-CHAIR BEFORE IT IS SIGNED BY THEM. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH CONFLICT OF INTEREST POLICY IS MONITORED ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 SALARY INCREASES ARE GRANTED ON AN ACROSS-THE-BOARD PERCENTAGE BASIS FOR ALL EMPLOYEES, INCLUDING THE EXECUTIVE DIRECTOR AND KEY EMPLOYEES. INCREASES ARE VOTED UPON BY THE BOARD OF TRUSTEES AND DOCUMENTED IN THE MINUTES TO THEIR MEETING. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: TEAMSTERS UNION 25 HEALTH SERVICES & INSURANCE PLAN'S BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT AUDITOR THAT PERFORMS THE AUDIT. FORM 990, PART V, LINE 2A: TEAMSTERS UNION 25 HEALTH SERVICES & INSURANCE PLAN ALSO ISSUES FORMS W-2 FOR THE DISABILITY BENEFIT (THIRD-PARTY SICK PAY) OFFERED BY THE PLAN. 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