2021-09-01T08:54:26-05:00 2020-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2019-12-01 042088633 SHEET METAL WORKERS LOCAL UNION NO 17 INSURANCE FUND SHEE 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 ROBERT KEOGH FUND ADMINISTRATOR 6174265646 2021-08-30 1 JEANNIE MICKEL P01058630 9789751099 2019 2022-09-23 18:48:47Z ROBERT KEOGH 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 41383382 0 X N/A X 1950 MA TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE PARTICIPANTS 6 6 29 0 0 0 0 0 42221518 36656214 1650168 792404 642279 727329 44513965 38175947 0 0 39027707 33764559 873150 911212 0 0 0 632215 696470 40533072 35372241 3980893 2803706 65814278 71089053 5818207 4397140 59996071 66691913 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 0 0 TO PROVIDE HEALTH AND OTHER SPECIFIED BENEFITS TO ELIGIBLE MEMBERS/DEPENDENTS THROUGH A COLLECTIVELY BARGAINED MULTIEMPLOYER PLAN. 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 3 0 1 29 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 0 0 1 1 0 0 1 0 0 1 0 1 0 X ROBERT KEOGH 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 X JAMES WOOL TRUSTEE 10.00 X X 0 0 0 KEVIN GILL TRUSTEE 10.00 X X 0 0 0 JOSEPH CULLEN TRUSTEE 10.00 X X 0 0 0 JACK DESMOND TRUSTEE 10.00 X X 0 0 0 RICHARD KEOGH TRUSTEE 10.00 X 0 0 0 ROBERT BUTLER TRUSTEE 10.00 X 0 0 0 ROBERT KEOGH ADMINISTRATOR 40.00 X 233213 0 123849 233213 0 123849 1 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 1175181 DELTA DENTAL 465 MEDOFRD STREET BOSTON MA 02129 DENTAL CLAIMS ADMINISTRATION 112759 ENVISION RX 2181 E AURORA ROAD TWINSBURG OH 44087 PRESCRIPTION CLAIMS ADMINSTRATION 110542 3 EMPLOYER CONTRIBUTIONS 561000 34721867 34721867 MEMBER CONTRIBUTIONS 561000 1435616 1435616 SASMI CONTRIBUTIONS 561000 498731 498731 36656214 720379 720379 3279460 3207435 72025 72025 72025 ADMIN ASSESSMENTS 900099 695570 695570 STOP LOSS REIMBURSEMENTS 900099 31759 31759 727329 38175947 37383543 0 792404 33764559 327110 215246 199877 140400 28579 7500 54632 121888 34283 8238 56255 37048 7070 34779 23240 STOPLOSS INSURANCE 263784 POSTAGE 14132 TELEPHONE 13179 ACA FEES 11552 8890 35372241 4504940 3584694 6240977 6018571 58364 75455 1228414 635132 624795 593282 52164449 57993151 2220753 2823900 65814278 71089053 223964 283952 5594243 4113188 5818207 4397140 X 0 0 0 0 59996071 66691913 59996071 66691913 65814278 71089053 2803706 3892136 0 X X 0 1 X 1 0 810927 272668 538259 417487 362464 55023 593282 LONGVIEW LARGECAP 500 18877520 F INSTITUTIONAL SENIOR LOAN FUND 4452678 F BAIRD INTERMEDIATE BOND 18852916 F NHIT CORE PLUS DISCRETION TRUST 11825561 F US REAL ESTATE INVEST FUND 3984476 F 57993151 INCURRED BUT NOT REPORTED CLAIMS 3680435 BENEFITS PAYABLE 432753 4113188 X 41946195 3892136 3892136 38054059 121888 121888 38175947 36731408 0 36731408 121888 -1481055 -1359167 35372241 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 (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE DEPARTMENT OF LABOR AND INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF NOVEMBER 30, 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: NET CHANGE IN BENEFIT OBLIGATIONS -1,481,055. X 0 0 0 ROBERT KEOGH ADMINISTRATOR 233213 0 0 0 0 0 95769 0 28080 0 357062 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 COLLECTIVELY BARGAINED MULTIEMPLOYER PLAN FOR MEMBERS AND RETIREES OF LOCAL 17 SMW FORM 990, PART VI, SECTION B, LINE 11B BOARD OF TRUSTEES HAS GIVEN AUTHORITY TO THE FUND ADMINISTRATOR TO REVIEW ALL TAX DOCUMENTATION BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12 AS AN EMPLOYEE BENEFIT PLAN WE ARE SUBJECT TO THE CONFLICTS OF INTEREST REQUIREMENTS OF ERISA. FORM 990, PART VI, SECTION B, LINE 15B COMPENSATION IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST FORM 990, PART XII, LINE 2C: NO CHANGE IN OVERSIGHT PROCESS OR SELECTION OF INDEPENDENT ACCOUNTANT. 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