2016-10-13T13:59:55-05:00 2015-12-31 510435869 Needles & Associates LLC 350 Interlocken Blvd STE 360 Broomfield CO 80021 990 2015-01-01 526279969 Mid-South Carpenters Regional Council Health and Welfare Fund MID- 6158590131 PO Box 1449 Goodlettsville TN 37070 Mike Boner Trustee 6158590131 2016-10-12 1 Kurt D Needles P00850236 3034304225 2016-10-13 2015 2017-02-10 21:41:12Z Mike Boner PO Box 1449 Goodlettsville TN 37070 29356456 0 X N/A X 1985 TN Provide health and welfare benefits to eligible participants. 13 0 0 0 0 0 0 0 19987761 20741186 94439 281892 0 0 20082200 21023078 0 0 11841089 14191459 0 0 0 0 0 1816027 1734673 13657116 15926132 6425084 5096946 12392124 19059273 7989950 9688966 4402174 9370307 Provide health and welfare benefits to eligible participants. 0 0 Provide health and welfare benefits to eligible participants. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 X 13 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 X Board of Trustees 6158590131 2001 Caldwell Drive Goodlettsville TN 37072 X Mike Boner Trustee 1.00 X 0 0 0 David Park Trustee 1.00 X 0 0 0 Larry Kerley Trustee 1.00 X 0 0 0 Russ Lambert Trustee 1.00 X 0 0 0 Ray Trawick Trustee 1.00 X 0 0 0 Victor White Trustee 1.00 X 0 0 0 Timothy Burns Trustee 1.00 X 0 0 0 Lloyd Hicks Trustee 1.00 X 0 0 0 Joseph Helton Trustee 1.00 X 0 0 0 Michael Pfieffer Trustee 1.00 X 0 0 0 Clyde Tyree Trustee 1.00 X 0 0 0 Larry Parks Trustee 1.00 X 0 0 0 Mark Brodd Trustee 1.00 X 0 0 0 0 0 0 0 0 0 0 Blue Cross Blue Shield of Tennessee 1 Cameron Hill Circle Chattanooga TN 37402 Administrative 917731 Southern Benefit Administrators 2001 Caldwell Drive Goodlettsville TN 37072 Administrative 500725 2 Employer Contributions 525100 18958113 18958113 Reciprocity (net) 525100 1247087 1247087 Employee Contributions 525100 535986 535986 20741186 262551 262551 8352719 8333378 19341 19341 19341 21023078 20741186 0 281892 14191459 480725 18542 41687 31734 944931 23577 3738 7390 ACA Fees 181096 Misc. 1253 15926132 3040190 1875797 1936482 2567613 2018014 2265371 5397438 12350492 12392124 19059273 364816 334618 7625134 9354348 7989950 9688966 X 4402174 9370307 4402174 9370307 12392124 19059273 5096946 -128813 0 X 0 1 X 1 0 0 Hour Bank Liability 7015590 Claims Payable - IBNR 2338758 9354348 X 20894265 -128813 -128813 21023078 0 21023078 14196918 0 14196918 1729214 1729214 15926132 Part X, Line 2: The Internal Revenue Service has determined that the Plan is exempt from federal income tax under Internal Revenue Code Section 501(c)(9). The Trust established to hold the Plan's assets obtained its original determination letter dated April 5, 1988, in which the Internal Revenue Service stated that the trust, as then designed, was in compliance with the applicable requirements of the Internal Revenue Code. The trust has been amended since receiving the determination letter. However, the Plan's Administrator and the Plan's tax counsel believe that the trust is currently designed and being operated in compliance with the applicable requirements of the Internal Revenue Code. Management has evaluated the Plan's tax positions and concluded that the Plan has maintained its tax exempt status and had taken no uncertain tax positions that would require financial statement adjustment or disclosure for the years ended December 31, 2015 and 2014. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. With few exceptions, the Plan is no longer subject to income tax examinations for years preceding December 31, 2011. Part XII, Line 4b - Other Adjustments: Change in Hour Bank Liability Change in Claims Payable Form 990, Part VI, Section B, line 11 Form 990 was provided to the Trustees for their review prior to filing. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy during board of trustee meetings. Form 990, Part VI, Section C, line 18 The Form 990 is available for public inspection upon pubic request. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents available upon public request. Contact fund administrator for information needed for Sch R Part III & IV N/A NA TN 37214 000000000 N/A TN 0 0 Contact fund administrator for information needed for Sch R Part III & IV N/A NA TN 37072 000000000 N/A TN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0