2019-06-28T10:36:29-05:00 2018-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2017-12-01 046063733 HEALTH AND WELFARE TRUST FUND LOCAL 103 IBEW HEAL 6172885999 256 FREEPORT STREET BOSTON MA 02122 MICHAEL P DONOVAN FUND ADMINISTRATOR 6172885999 2019-06-26 1 JEANNIE MICKEL P01058630 9789751099 173.162.188.213 2019-06-28 11:35:29 ED P 7ADBD96C547CBE419AC9B87DCFC7EE63ECE44F7B A54CA6112FE5A8F0A286552BC749CAA8FA9601AC 2017 2019-02-21 02:37:17Z MICHAEL P DONOVAN 256 FREEPORT STREET BOSTON MA 02122 497569201 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 125179448 141409038 4261235 3838360 1914050 1998000 131354733 147245398 0 0 98060627 106769129 2617068 2483508 0 0 0 2519064 2455322 103196759 111707959 28157974 35537439 325209757 360392432 20315315 17719466 304894442 342672966 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 1 184 0 1 25 1 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 CHARLES MONAHAN 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 JOSEPH MCCLUSKEY TRUSTEE 1.00 X 0 0 0 ROBERT SHEEHAN JR TRUSTEE 1.00 X 0 0 0 MICHAEL DONOVAN FUND ADMINISTRATOR 22.00 33.00 X 72846 118735 61819 RICHARD GAMBINO FUND ADMINISTRATOR 24.75 30.25 X 65520 110412 61819 138366 229147 123638 0 1 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 2288095 DELTA DENTAL 46 MEDFORD STREET BOSTON MA 02129 HEALTH CARE ADMINISTRATION 306603 LOOMIS SAYLES ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 238326 MODERN ASSISTANCE 1458 HANCOCK STREET QUINCY MA 02169 HEALTH CARE ADMINISTRATION 236038 BLACKROCK 40 EAST 52ND STREET NEW YORK NY 10022 INVESTMENT MANAGEMENT 235252 9 EMPLOYER CONTRIBUTIONS 137568675 137568675 PARTICIPANT SELF-PAYMENTS 3840363 3840363 141409038 5922903 5922903 348239260 350323803 -2084543 -2084543 -2084543 ADMIN EXPENSE REIMBURSEMENTS 1998000 1998000 1998000 147245398 143407038 0 3838360 106769129 327715 1132345 359503 550035 113910 133674 42500 1013730 273503 107201 220838 78636 46869 79201 REPAIRS & MAINTENANCE 268074 POSTAGE 71458 EQUIPMENT LEASES 34431 PCORI FEES 26038 59169 111707959 6946931 4316574 20944646 37522754 11619091 12976192 54905 66257 1147194 583224 541701 563970 187555883 206733982 87147995 92998078 10398605 5214625 325209757 360392432 204963 316083 20110352 17403383 20315315 17719466 X 304894442 342672966 304894442 342672966 325209757 360392432 35537439 2241085 0 X X 0 1 X 1 0 652704 159908 492796 453990 407116 46874 40500 16200 24300 563970 S&P 500 COMMON TRUST 62149526 F MEPT EDGEMOOR LP-CLASS B 30848552 F 92998078 DUE TO INVESTMENT ACQUISITIONS 5104056 CONTRACTOR DEPOSITS 320524 DUE TO RELATED PARTIES 482577 BENEFITS CLAIMS PAYABLE 9431452 DUE TO RECIPROCALS 63118 DUE TO HEALTH PROVIDER 2001656 17403383 X 148472753 2241085 2241085 146231668 1013730 1013730 147245398 110965465 0 110965465 1013730 -271236 742494 111707959 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, 2018, 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 -271,236. X X X 0 0 0 MICHAEL DONOVAN FUND ADMINISTRATOR 72846 118735 0 0 0 0 39355 0 22464 0 134665 118735 0 0 RICHARD GAMBINO FUND ADMINISTRATOR 65520 110412 0 0 0 0 39355 0 22464 0 127339 110412 0 0 KAITLYN SHERMAN FAMILY MEMBER OF OFFICER 37249 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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