2020-08-05T11:04:26-05:00 2019-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2018-12-01 046063733 HEALTH AND WELFARE TRUST FUND LOCAL 103 IBEW HEAL 6172885999 256 FREEPORT STREET BOSTON MA 02122 MICHAEL P DONOVAN FUND ADMINISTRATOR 6172885999 2020-07-28 1 JEANNIE MICKEL P01058630 9789751099 173.162.188.213 2020-08-05 12:03:03 ED P 7ADBD96C547CBE419AC9B87DCFC7EE63ECE44F7B 57CAB1478FA21B4BB6BCA0ED5F2D8E49AC86AE59 2018 2020-09-23 17:36:50Z MICHAEL P DONOVAN 256 FREEPORT STREET BOSTON MA 02122 436189696 0 X WWW.TRUSTFUNDS103.COM X 1953 MA THE HEALTH BENEFIT PLAN PROVIDES FOR ACCIDENT, HOSPITAL, MEDICAL, PHARMACEUTICAL, SURGICAL, DENTAL, DISABILITY, AND DEATH BENEFITS FOR ELIGIBLE MEMBERS AND THEIR FAMILIES, AS SPECIFIED IN THE PLAN. 6 6 25 0 0 0 0 0 141409038 150368555 3838360 12380987 1998000 1824000 147245398 164573542 0 0 106769129 121109596 2483508 2186379 0 0 0 2455322 2576988 111707959 125872963 35537439 38700579 360392432 420279849 17719466 20480570 342672966 399799279 THE HEALTH BENEFIT PLAN PROVIDES FOR ACCIDENT, HOSPITAL, MEDICAL, PHARMACEUTICAL, SURGICAL, DENTAL, DISABILITY, AND DEATH BENEFITS FOR ELIGIBLE MEMBERS AND THEIR FAMILIES, AS SPECIFIED IN THE PLAN. 0 0 THE HEALTH BENEFIT PLAN PROVIDES FOR ACCIDENT, HOSPITAL, MEDICAL, PHARMACEUTICAL, SURGICAL, DENTAL, DISABILITY, AND DEATH BENEFITS FOR ELIGIBLE MEMBERS AND THEIR FAMILIES, AS SPECIFIED IN THE 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 1 0 0 0 0 0 0 1 0 0 1 162 0 1 25 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 1 0 X MICHAEL P DONOVAN 6172885999 256 FREEPORT STREET 2ND FLOOR BOSTON MA 02122 LOU ANTONELLIS TRUSTEE 1.00 X 0 0 0 GLENN KINGSBURY TRUSTEE 1.00 X 0 0 0 MICHAEL MCDONALD TRUSTEE 1.00 X 0 0 0 ROBERT SHEEHAN JR TRUSTEE 1.00 X 0 0 0 RICHARD ANTONELLIS TRUSTEE 1.00 X 0 0 0 ALAN SCHARFE TRUSTEE 1.00 X 0 0 0 MICHAEL DONOVAN FUND ADMINISTRATOR 22.00 33.00 X 77502 116253 63071 JOSHUA WOOD ACCOUNTING MANAGER 9.80 30.20 X 27420 84498 54435 RICHARD GAMBINO FUND ADMINISTRATOR 24.75 30.25 X 62968 76961 47514 167890 277712 165020 0 1 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 2474245 DELTA DENTAL 46 MEDFORD STREET BOSTON MA 02129 HEALTH CARE ADMINISTRATION 330444 MODERN ASSISTANCE 1458 HANCOCK STREET QUINCY MA 02169 HEALTH CARE ADMINISTRATION 262862 LOOMIS SAYLES ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 256205 ZENITH AMERICAN SOLUTIONS 33 EASTLAND STREET SPRINGFIELD MA 01109 HEALTH CARE ADMINISTRATION 211782 9 EMPLOYER CONTRIBUTIONS 146454617 146454617 PARTICIPANT SELF-PAYMENTS 3913938 3913938 150368555 7406318 7406318 276590823 271616154 4974669 4974669 4974669 ADMIN EXPENSE REIMBURSEMENTS 1824000 1824000 1824000 164573542 152192555 0 12380987 121109596 209046 1075370 294948 505756 101259 208147 42500 910822 403478 111067 224733 59884 46209 77922 REPAIRS & MAINTENANCE 265929 POSTAGE 104143 EQUIPMENT LEASES 46893 PCORI FEES 28979 46282 125872963 4316574 11300626 37522754 33906161 12976192 14463636 66257 50729 1190537 629433 563970 561104 206733982 248692141 92998078 108574662 5214625 2730790 360392432 420279849 316083 227336 17403383 20253234 17719466 20480570 X 342672966 399799279 342672966 399799279 360392432 420279849 38700579 18425734 0 X X 0 1 X 1 0 676648 429873 246775 473389 175260 298129 40500 24300 16200 561104 S&P 500 COMMON TRUST 76340335 F MEPT EDGEMOOR LP-CLASS B 32234327 F 108574662 DUE TO INVESTMENT ACQUISITIONS 2036049 CONTRACTOR DEPOSITS 305524 DUE TO RELATED PARTIES 2727415 BENEFITS CLAIMS PAYABLE 11303507 DUE TO RECIPROCALS 135537 DUE TO HEALTH PROVIDER 3745202 20253234 X 182088454 18425734 18425734 163662720 910822 910822 164573542 123090086 0 123090086 910822 1872055 2782877 125872963 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, 2019, 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 BENEFITS PAYABLE 1,872,055. X X X 0 0 0 MICHAEL DONOVAN FUND ADMINISTRATOR 77502 116253 0 0 0 0 40607 0 22464 0 140573 116253 0 0 JOSHUA WOOD ACCOUNTING MANAGER 27420 84498 0 0 0 0 31971 0 22464 0 81855 84498 0 0 RICHARD GAMBINO FUND ADMINISTRATOR 62968 76961 0 0 0 0 30666 0 16848 0 110482 76961 0 0 KAITLYN SHERMAN FAMILY MEMBER OF OFFICER 29829 COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT VERSION OF THE FORM 990 IS REVIEWED BY THE FUND ADMINISTRATOR, THE FINAL COPY IS PROVIDED TO THE FULL BOARD OF TRUSTEES FOR REVIEW PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12 THE ORGANIZATION FOLLOWS A CONFLICT OF INTEREST POLICY IN ACCORDANCE WITH ERISA FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S OFFICERS IS DETERMINED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FORM 990 AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS DID NOT CHANGE FROM PRIOR YEAR. 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