2020-09-25T09:18:48-05:00 2019-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2018-12-01 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 2020-09-24 1 JEANNIE MICKEL P01058630 9789751099 173.162.188.213 2020-09-25 10:01:17 ED P 7ADBD96C547CBE419AC9B87DCFC7EE63ECE44F7B 57CAB1478FA21B4BB6BCA0ED5F2D8E49AC86AE59 2018 2021-09-10 13:11:23Z ROBERT KEOGH 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 48637641 0 X N/A X 1950 MA TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE PARTICIPANTS 6 6 41 0 0 0 0 0 37133616 42221518 2140887 1650168 726984 642279 40001487 44513965 0 0 34087049 39027707 827163 873150 0 0 0 272523 632215 35186735 40533072 4814752 3980893 57722359 65814278 4746956 5818207 52975403 59996071 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 41 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 236100 0 122789 236100 0 122789 1 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 1171686 ENVISION RX 2181 E AURORA ROAD TWINSBURG OH 44087 PRESCRIPTION CLAIMS ADMINSTRATION 115571 DELTA DENTAL 465 MEDOFRD STREET BOSTON MA 02129 DENTAL CLAIMS ADMINISTRATION 112254 3 EMPLOYER CONTRIBUTIONS 561000 40913022 40913022 MEMBER CONTRIBUTIONS 561000 1135042 1135042 SASMI CONTRIBUTIONS 561000 173454 173454 42221518 788748 788748 4985096 4123676 861420 861420 861420 ADMIN ASSESSMENTS 900099 627522 627522 SETTLEMENT INCOME 900099 14757 14757 642279 44513965 42863797 0 1650168 39027707 239185 244774 217449 137280 34462 8514 26350 113672 66872 9708 49104 32450 17176 34743 22940 STOPLOSS INSURANCE 195278 TEMPORARY HELP/BOOKKEEP 17300 TELEPHONE 12731 ACA FEES 11043 14334 40533072 3771821 4504940 6301543 6240977 39799 58364 1225147 600352 659569 624795 44865407 52164449 2084220 2220753 57722359 65814278 237231 223964 4509725 5594243 4746956 5818207 X 0 0 0 0 52975403 59996071 52975403 59996071 57722359 65814278 3980893 3039775 0 X X 0 1 X 1 0 807660 251923 555737 417487 348429 69058 624795 LONGVIEW LARGECAP 500 16093285 F INSTITUTIONAL SENIOR LOAN FUND 3942360 F INSTL MULTI-STRATEGY 3890057 F BAIRD INTERMEDIATE BOND 14747472 F NHIT CORE PLUS DISCRETION TRUST 9524252 F US REAL ESTATE INVEST FUND 3967023 F 52164449 INCURRED BUT NOT REPORTED CLAIMS 4945464 BENEFITS PAYABLE 648779 5594243 X 47440068 3039775 3039775 44400293 113672 113672 44513965 39334882 0 39334882 113672 1084518 1198190 40533072 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 BENEFIT OBLIGATIONS 1,084,518. X 0 0 0 ROBERT KEOGH ADMINISTRATOR 236100 0 0 0 0 0 95333 0 27456 0 358889 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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