2014-08-15T12:46:17-05:00 2013-12-31 510435869 Needles & Associates LLC 350 Interlocken Blvd STE 220 Broomfield CO 80021 990 2013-01-01 526279969 Mid-South Carpenters Regional Council He MID- 4056822323 PO Box 1449 Goodlettsville TN 37070 Mike Boner Trustee 4056822323 2014-08-04 Kurt D Needles P00850236 3034304225 2014-08-15 2013 2016-02-25 16:41:14Z Mike Boner PO Box 1449 Goodlettsville TN 37070 18576630 0 X N/A X 1985 TN Provide medical benefits for participants. 15 0 0 0 0 0 0 0 18976110 18160458 281431 94382 41777 321790 19299318 18576630 0 0 18083678 20702471 518 105583 0 0 0 1667676 1612316 19751872 22420370 -452554 -3843740 10677190 8841096 8590459 11800789 2086731 -2959693 Provide health and welfare benefits to eligible participants. 0 0 20314547 Benefits paid to eligible participants and dependents. 387924 Insurance premium paid for participants and their dependents. Change in IBNR and hour bank liability. 20702471 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 0 0 0 0 0 0 0 0 0 0 0 X 15 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X Board of Trustees 4056822323 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 Victor White Trustee 1.00 X 0 0 0 Ray Trawick Trustee 1.00 X 0 0 0 Tim Brown Trustee 1.00 X 0 0 0 Donald Finley Trustee 1.00 X 0 0 0 Lloyd Hicks Trustee 1.00 X 0 0 0 Wayne Jennings 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 1129668 Southern Benefit Administrators 2001 Caldwell Drive Goodlettsville TN 37072 Administrative 381665 2 Employer Contributions 525100 16726615 16726615 Reciprocity In 525100 1386981 1386981 Employee Contributions 525100 895885 895885 Reciprocity Out 525100 -849023 -849023 18160458 94382 94382 Formulary Rebates 525100 182079 182079 Subrogation Refunds 525100 120634 120634 Late Penalties 525100 18957 18957 120 120 321790 18576630 18482248 0 94382 20702471 20702471 104511 104511 1072 1072 381665 381665 19317 19317 51637 51637 22862 22862 1081335 1081335 36917 36917 847 847 4848 4848 11868 11868 Other expenses-Mngmnt-9 1020 1020 22420370 20702471 1717899 0 1059283 1239753 573951 2283537 1947622 1819514 0 0 7096334 3498292 10677190 8841096 253212 233839 8337247 11566950 8590459 11800789 X 2086731 -2959693 2086731 -2959693 10677190 8841096 -3843740 -1202684 0 X 0 0 0 0 Hour Bank Liability 9301179 Claims Payable - IBNR 2265771 11566950 X 17373946 -1202684 -1202684 18576630 0 18576630 22117538 0 22117538 302832 302832 22420370 Part X, Line 2: The Trust established under the Fund to hold the Fund's net assets is qualified pursuant to Section 501(c)(9) of the Internal Revenue Code, and accordingly, the trust's net investment income is exempt from income taxes. The Fund obtained a favorable tax determination letter dated April 5, 1988, from the Internal Revenue Service and the Fund believes that the trust, as amended, continues to qualify and to operate as designed. Management has evaluated the Fund's tax positions and concluded that the Fund has maintained its tax exempt status and had taken no uncertain tax positions that required adjustments to the financial statements. Therefore, they believe that the Fund was qualified and the related trust was tax-exempt as of the financial statement date. 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 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. Info not available for Sch R Part III & IV N/A NA TN 37214 000000000 N/A TN 0 0 Info not available 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