2024-09-06T11:39:42-05:00 2024-04-30 043728817 TRONCONI SEGARRA & ASSOCIATES LLP 8321 MAIN STREET WILLIAMSVILLE NY 14221 990 2023-05-01 161561710 UA PLUMBERS AND STEAMFITTERS LOCAL 22 HEALTH FUND UAPL 7166688800 120 GARDENVILLE PARKWAY STE 3 WEST SENECA NY 14224 RICHARD EVANS TRUSTEE 7166688800 2024-09-06 1 0 DIANE M STRAKA CPA P00165826 7166331373 2024-09-06 2023 2024-08-08 14:25:15Z RICHARD EVANS 120 GARDENVILLE PARKWAY STE 3 WEST SENECA NY 14224 19740589 0 X WWW.LOCAL22BENEFITS.COM X 1999 NY TO PROVIDE MEMBERS WITH MEDICAL, DISABILITY AND LIFE INSURANCE BENEFITS. 8 4 25 0 0 0 0 0 15503163 16938082 -22253 719753 1195517 2082754 16676427 19740589 0 0 14844444 14725354 523096 573322 0 0 0 822497 706826 16190037 16005502 486390 3735087 21729540 25573786 441876 466429 21287664 25107357 TO PROVIDE MEMBERS WITH MEDICAL, DISABILITY AND LIFE INSURANCE BENEFITS. 0 0 THE FUND PROVIDED MEDICAL, VISION, DENTAL, GROUP LIFE, AND DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 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 1 3 0 1 25 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 1 1 0 X DEBRA KORPOLINSKI 7166888800 120 GARDENVILLE PARKWAY STE 3 WEST SENECA NY 14224 SEAN REDDEN TO 9123 TRUSTEE 1.00 56.00 X 0 0 72658 RICHARD BLY TRUSTEE 1.00 48.00 X 963 35194 25837 H VAN MOLLENBERG TO 1124 TRUSTEE 1.00 1.00 X 0 0 0 DAVID MUSKOPF JR TRUSTEE 1.00 1.00 X 0 0 0 JEFFREY ZUBLER TRUSTEE 1.00 48.00 X 0 101261 86257 MICHAEL BEMENT TRUSTEE 1.00 1.00 X 0 0 0 RICHARD EVANS TRUSTEE 1.00 56.00 X 0 106505 0 CHRISTOPHER TRYJANKOWSKI TRUSTEE 1.00 1.00 X 0 0 0 JOEL BROCK FROM 9123 TRUSTEE 1.00 X 0 0 0 ADAM MOLLENBERG FROM 1124 TRUSTEE 1.00 1.00 X 0 0 0 DEBRA KORPOLINSKI FUND ADMINISTRATOR 16.00 24.00 X 155865 0 57054 156828 242960 241806 1 0 1 0 0 EMPLOYER CONTRIBUTIONS 900099 16069669 16069669 MEMBER CONTRIBUTIONS 900099 868413 868413 16938082 705637 705637 14116 0 14116 14116 14116 STOP LOSS REIMBURSEMENTS 900099 992170 992170 PRESCRIPTION REBATES AND TRUE-UPS 900099 683720 683720 REIMBURSED EXPENSES 900099 386741 386741 20123 20123 2082754 19740589 19020836 0 719753 14725354 232933 150554 101717 62136 25982 57967 41269 16858 447581 53191 14671 37620 8038 4640 19897 PCORI FEES 5094 16005502 3196670 6369004 1212026 39824 1501597 1591748 65208 41044 9821 24164 14652384 16633306 1157042 915740 21729540 25573786 17761 64082 424115 402347 441876 466429 X 0 0 0 0 21287664 25107357 21287664 25107357 21729540 25573786 3735087 84606 0 X 0 1 X 1 0 65208 41044 24164 24164 OPERATING LEASE OBLIGATION 399397 DUE TO MEMBERS 2950 402347 19421596 84606 84606 19336990 16858 386741 403599 19740589 15601903 0 15601903 16858 386741 403599 16005502 PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED EXPENSES 386,741. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED EXPENSES 386,741. 0 0 0 DEBRA KORPOLINSKI FUND ADMINISTRATOR 155865 0 0 0 0 0 35318 0 21736 0 212919 0 0 0 JEFFREY ZUBLER TRUSTEE 0 101261 0 0 0 0 0 61579 0 24678 0 187518 0 0 FORM 990, PART VI, SECTION B, LINE 11B FORM IS EMAILED TO ALL TRUSTEES FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS REVIEWED ANNUALLY AT THE BOARD OF TRUSTEES MEETING AND ANY CONFLICTS MUST BE DISCLOSED, DISCUSSED AND RESOLVED FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PAGE 6, PART VI, LINE 15A: THE FUND ADMINISTRATOR WORKS UNDER A MANAGERIAL EMPLOYMENT CONTRACT. THE BOARD APPOINTS A COMMITTEE THAT PERFORMS A SALARY COMPARISON, REVIEWS THE PERFORMANCE AND EXPECTATIONS OF THE BOARD AND FUND ADMINISTRATOR, AND MAKES RECOMMENDATIONS TO THE BOARD FOR APPROVAL. FORM 990 PAGE 6 PART VI, LINE 15B: UNION TRUSTEES ARE COMPENSATED FOR LOST TIME FOR ATTENDING BOARD OF TRUSTEE MEETINGS. THE TRUSTEE IS COMPENSATED AT A RATE EQUAL TO WHAT THE TRUSTEE'S COMPENSATION AND BENEFITS WOULD BE HAD HE WORKED FOR HIS EMPLOYER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. 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