2018-10-11T14:33:44-05:00 2017-12-31 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2017-01-01 042219623 TEAMSTERS LOCAL 170 HEALTH AND WELFARE FUND TEAM 5087913416 330 SOUTHWEST CUTOFF WORCESTER MA 01607 SHANNON GEORGE TRUSTEE 5087913416 2018-10-11 1 JEANNIE MICKEL P01058630 9789751099 173.162.188.213 2018-10-11 15:32:31 ED P 7ADBD96C547CBE419AC9B87DCFC7EE63ECE44F7B A54CA6112FE5A8F0A286552BC749CAA8FA9601AC 2017 2018-06-14 16:35:46Z SHANNON GEORGE 330 SOUTHWEST CUTOFF WORCESTER MA 01607 38204076 0 X N/A X TRUST 1954 MA TO PROVIDE MEDICAL, DENTAL, VISION, LIFE, ACCIDENT & SICKNESS BENEFITS TO ELIGIBLE PARTICIPANTS 6 6 8 0 0 0 0 0 30491227 30926495 818136 1007055 210081 197446 31519444 32130996 0 0 24537275 26085805 680197 722043 0 0 0 1393928 1334679 26611400 28142527 4908044 3988469 47115938 53239765 8694077 8447646 38421861 44792119 TO PROVIDE MEDICAL, DENTAL, VISION, LIFE, ACCIDENT & SICKNESS BENEFITS TO ELIGIBLE PARTICIPANTS 0 0 PROVIDE WELFARE BENEFITS TO EMPLOYEES UNDER COLLECTIVE BARGAINING AGREEMENT 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 10 0 1 8 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 0 0 1 1 0 0 1 0 1 1 0 1 0 X SHANNON GEORGE 5087913416 330 SOUTHWEST CUTOFF WORCESTER MA 01607 X SHANNON GEORGE TRUSTEE/CO-CHAIR 10.00 X 0 0 0 PAUL E DAUPHINAIS TRUSTEE 10.00 X 0 0 0 EDWARD J ADLEY TRUSTEE 10.00 X 0 0 0 SEAN M FOLEY TRUSTEE 10.00 X 0 0 0 RONALD J BEVENS TRUSTEE 10.00 X 0 0 0 MAURICE J LANGLOIS TRUSTEE 10.00 X 0 0 0 RAYMOND REED EMPLOYEE 40.00 X 152884 0 47822 152884 0 47822 1 0 1 0 BLUE CROSS BLUE SHIELD 25 TECHNOLOGY PLACE HINGHAM MA 02043 CLAIMS ADMIN 874900 1 EMPLOYER CONTRIBUTIONS 900099 30051261 30051261 EMPLOYEE CONTRIBUTIONS 900099 875234 875234 30926495 1008963 1008963 196600 0 196600 196600 196600 6071172 6073080 -1908 -1908 -1908 OTHER INCOME 900099 846 846 846 32130996 30927341 0 1203655 26085805 416343 143798 126818 35084 69985 75064 96452 168564 329975 59858 268131 44322 STOP LOSS 212665 PCORI EXCISE TAX 8913 TRANSITIONAL REINSURANC 750 28142527 2604586 2718492 4684231 7622559 2557215 2493285 43252 77366 7830684 4106514 3697224 3724170 21762099 22476212 11610476 13969376 156855 158305 47115938 53239765 101658 115955 8592419 8331691 8694077 8447646 X 0 0 0 0 38421861 44792119 38421861 44792119 47115938 53239765 3988469 2381789 0 X X 0 1 X 0 0 534151 534151 5875600 3151456 2724144 506594 402055 104539 507654 249133 258521 406685 303870 102815 3724170 FIDELITY INFLAT-PROTBOND INDEX 4311257 F FIDELITY 500 INDEX PREMIUM CLASS 6122683 F FIDELITY INTL INDEX PREMIUM 3535436 F 13969376 EST. INCURRED BUT UNREPORTED CLAIMS 8321881 CONTRACTOR DEPOSITS 9810 8331691 X 34437721 2381789 2381789 32055932 75064 75064 32130996 28328040 0 28328040 75064 -260577 -185513 28142527 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 DECEMBER 31, 2017, 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: CHANGE IN BENEFITS PAYABLE PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFITS PAYABLE X 0 0 0 RAYMOND REED EMPLOYEE 152884 0 0 0 0 0 23138 0 24684 0 200706 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 COLLECTIVELY BARGAINED MULTIEMPLOYER PLAN FOR MEMBERS OF TEAMSTERS LOCAL 170 HEALTH AND WELFARE FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF TRUSTEES HAS GRANTED THE FUND ADMINSTRATOR AUTHORITY TO REVIEW AND FILE ALL TAX DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 12 AS AN EMPLOYEE BENEFIT PLAN, THE ORGANIZATION IS SUBJECT TO THE CONFLICTS OF INTEREST REQUIREMENTS OF ERISA FORM 990, PART VI, SECTION B, LINE 15B BOARD OF TRUSTEES REVIEWS KEY EMPLOYEES COMPENSATION WITH COMPARABILITY DATA ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND AUDITED FINANCIAL STATEMENTS OF THE ORGANIZATION ARE AVAILABLE UPON REQUEST FORM 990, PART XII, LINE 2C: NO CHANGE IN OVERSIGHT PROCESS OR SELECTION OF INDEPENDANT ACCOUNTANT. 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