2014-09-15T14:16:57-05:00 2013-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET STE 140 NORTH ANDOVER MA 01845 990 2012-12-01 046063733 HEALTH AND WELFARE TRUST FUND LOCAL 103 IBEW HEAL 6172885999 256 FREEPORT STREET BOSTON MA 02122 MICHAEL P DONOVAN 6172885999 2014-09-15 1 JEANNIE MICKEL P01058630 9789751099 2012 2015-11-30 17:44:51Z RICHARD P GAMBINO 256 FREEPORT STREET BOSTON MA 02122 636394536 0 X N/A 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 29 0 0 0 0 0 78964222 94413420 4893803 2762499 1380000 1664290 85238025 98840209 0 0 68003543 70242962 2093811 2223506 0 0 0 4584855 2013161 74682209 74479629 10555816 24360580 147515148 178566023 9986361 11341124 137528787 167224899 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 1810 0 1 29 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 RICHARD P GAMBINO 6172885999 256 FREEPORT STREET 2ND FLOOR BOSTON MA 02122 MICHAEL MONAHAN 1.00 X 0 0 0 JOHN DUMAS 1.00 X 0 0 0 CHARLES MONAHAN 1.00 X 0 0 0 GLENN KINGSBURY 1.00 X 0 0 0 JOSEPH BODIO 1.00 X 0 0 0 PAUL GUARRACINO 1.00 X 0 0 0 RICHARD GAMBINO 20.00 20.00 X 60757 94373 52570 MICHAEL DONOVAN 15.00 25.00 X 54215 100190 47746 114972 194563 100316 0 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 2213285 SEGAL ROITMAN LLP 111 DEVONSHIRE ST BOSTON MA 02109 LEGAL 227876 BLACKROCK FINANCIAL MGMT ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 221143 MODERN ASSISTANCE 1458 HANCOCK STREET QUINCY MA 02169 HEALTH CARE ADMINISTRATION 156279 LOOMIS SAYLES ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 149154 7 EMPLOYER CONTRIBUTIONS 90942068 90942068 PARTICIPANT SELF-PAYMENTS 3471352 3471352 94413420 2565046 2565046 537751780 537554327 197453 197453 197453 ADMIN EXPENSE REIMBURSEMENTS 1664290 1664290 1664290 98840209 96077710 0 2762499 70242962 306793 991234 212800 606120 106559 226208 42500 528974 365134 27525 222939 57081 52457 68235 REPAIRS & MAINTENANCE 161864 POSTAGE 97250 EQUIPMENT LEASES 42848 BANK CHARGES 34627 85519 74479629 12150439 13175377 1048449 9878628 7041206 8129956 17819 0 697051 353611 120433 343440 96807435 109210245 25743746 33540481 4585621 4287896 147515148 178566023 169337 217095 9817024 11124029 9986361 11341124 X 137528787 167224899 137528787 167224899 147515148 178566023 24360580 5335532 0 X X 0 1 X 1 0 336499 93822 242677 328716 253422 75294 31836 6367 25469 343440 S&P 500 COMMON TRUST 33540481 F 33540481 DUE TO INVESTMENT ACQUISITIONS 4254928 CONTRACTOR DEPOSITS 240524 DUE TO RELATED PARTIES 418207 BENEFITS CLAIMS PAYABLE 6210370 11124029 X 103646767 5335532 5335532 98311235 528974 528974 98840209 74379621 0 74379621 528974 -428966 100008 74479629 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013, 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 -428,966. X X X 0 0 0 RICHARD GAMBINO 60757 94373 0 0 0 0 15450 0 37120 0 113327 94373 0 0 MICHAEL DONOVAN 54215 100190 0 0 0 0 10626 0 37120 0 101961 100190 0 0 KAITLYN GAMBINO FAMILY MEMBER OF OFFICER 29640 COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11 A DRAFT VERSION OF THE FORM 990 IS REVIEWED BY THE FUND ADMINISTRATOR AND CFO, 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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