2014-09-02T12:15:22-05:00 2013-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET STE 140 NORTH ANDOVER MA 01845 990 2012-12-01 042088633 SHEET METAL WORKERS LOCAL UNION NO 17 INSURANCE FUND SHEE 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 ROBERT KEOGH 6174265646 2014-08-27 1 JEANNIE MICKEL P01058630 9789751099 2012 2015-11-30 17:44:51Z ROBERT KEOGH 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 55696638 0 X X 1950 MA TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE PARTICIPANTS 6 6 38 0 0 0 0 0 22102759 25396665 1355584 1487828 377260 430397 23835603 27314890 0 0 23385826 24522078 563444 610617 0 0 0 437583 448059 24386853 25580754 -551250 1734136 49915660 54590713 3839982 4646150 46075678 49944563 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 38 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 10.00 X X 0 0 0 FRED CREAGER 10.00 X X 0 0 0 KEVIN GILL 10.00 X X 0 0 0 FESTUS JOYCE 10.00 X X 0 0 0 JOSEPH CULLEN 10.00 X X 0 0 0 JACK DESMOND 10.00 X X 0 0 0 ROBERT KEOGH 40.00 X 192718 0 74413 192718 0 74413 1 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 1021359 1 EMPLOYER CONTRIBUTIONS 561000 23711779 23711779 SASMI CONTRIBUTIONS 561000 1021952 1021952 MEMBER CONTRIBUTIONS 561000 662934 662934 25396665 800570 800570 29069006 28381748 687258 687258 687258 ADMIN ASSESSMENTS 900099 430397 430397 430397 27314890 26514320 0 800570 24522078 185004 213195 180572 31846 22234 27121 156791 28277 10352 27092 35915 24715 43567 26583 POSTAGE 16604 PRINTING 9986 TELEPHONE 8680 ADMINISTRATIVE EXPENSE 8227 1915 25580754 250 1976518 2824525 4488302 4270631 21119 20141 1153092 429811 765151 723281 40912067 30580187 14288375 1752253 1883573 49915660 54590713 601217 626079 3238765 4020071 3839982 4646150 X 0 0 0 0 46075678 49944563 46075678 49944563 49915660 54590713 1734136 2134749 0 X X 0 1 X 1 0 807660 127667 679993 345432 302144 43288 723281 SSGA INDEX PLUS FUND 8072360 F INSTITUTIONAL SENIOR LOAN FUND 2529778 F MESIROW MULTISTRATEGY 3686237 F 14288375 INCURRED BUT NOT REPORTED CLAIMS 3723005 BENEFITS PAYABLE 297066 4020071 X 29292848 2134749 2134749 27158099 156791 156791 27314890 24903656 0 24903656 156791 520307 677098 25580754 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 BENEFIT OBLIGATIONS 520,307. X 0 0 0 ROBERT KEOGH 192718 0 0 0 0 0 0 0 74413 0 267131 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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