2016-09-15T10:33:51-05:00 2015-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2014-12-01 042088633 SHEET METAL WORKERS LOCAL UNION NO 17 INSURANCE FUND SHEE 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 ROBERT KEOGH FUNDS ADMINISTRATOR 6174265646 2016-09-13 1 JEANNIE MICKEL P01058630 9789751099 2014 2017-02-10 21:41:12Z ROBERT KEOGH 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 48195421 0 X X 1950 MA TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE PARTICIPANTS 6 6 43 0 27170183 0 0 0 24220303 27170183 3104189 4640365 466612 480827 27791104 32291375 0 0 27373150 27729626 630387 662231 0 0 0 397796 654430 28401333 29046287 -610229 3245088 54892611 53774041 5032748 4632829 49859863 49141212 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 0 0 TO PROVIDE HEALTH AND OTHER SPECIFIED BENEFITS TO ELIGIBLE MEMBERS/DEPENDANTS 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 2 0 1 43 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 0 1 0 1 0 X ROBERT KEOGH 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 JAMES WOOL TRUSTEE 10.00 X X 0 0 0 FRED CREAGER TRUSTEE 10.00 X X 0 0 0 KEVIN GILL TRUSTEE 10.00 X X 0 0 0 FESTUS JOYCE 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 ROBERT KEOGH ADMINISTRATOR 40.00 X 208518 0 92471 208518 0 92471 1 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 1017577 1 EMPLOYER CONTRIBUTIONS 561000 25955770 25955770 MEMBER CONTRIBUTIONS 561000 940256 940256 SASMI CONTRIBUTIONS 561000 274157 274157 27170183 928384 928384 19616027 15904046 3711981 3711981 3711981 ADMIN ASSESSMENTS 900099 480827 480827 480827 32291375 480827 27170183 4640365 27729626 209964 174086 169608 84864 23709 9334 19950 164314 39292 11162 26019 44660 10551 29455 23583 TRANSITIONAL REINSURANC 246330 ADMINISTRATIVE EXPENSE 9628 TELEPHONE 9373 POSTAGE 8079 2700 29046287 1058371 547165 4870570 4728138 32540 21711 1153092 501818 680730 651274 23535537 21607616 22658406 24004862 2056457 2213275 54892611 53774041 512895 308134 4519853 4324695 5032748 4632829 X 0 0 0 0 49859863 49141212 49859863 49141212 54892611 53774041 3245088 -3963739 0 X X 0 1 X 1 0 807660 169086 638574 345432 332732 12700 651274 AMALGAMATED LONGVIEW ULTRA 7640865 F INSTITUTIONAL SENIOR LOAN FUND 3744452 F MESIROW MULTISTRATEGY 3880814 F DPT CORE PLUS 8738731 F 24004862 INCURRED BUT NOT REPORTED CLAIMS 4047051 BENEFITS PAYABLE 277644 4324695 X 28163322 -3963739 -3963739 32127061 164314 164314 32291375 29077131 0 29077131 164314 -195158 -30844 29046287 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, 2015, 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 -195,158. X 0 0 0 ROBERT KEOGH ADMINISTRATOR 208518 0 0 0 0 0 71255 0 21216 0 300989 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 11 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 PROCESS HAS NOT CHANGED FROM PRIOR YEAR. 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