2014-10-09T11:10:14-05:00 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 2014-10-06 Kurt D Needles P00850236 3034304225 2014-10-09 2013 2015-11-30 17:44:51Z Amended: Form amended to reflect fin stmt changes. X Mike Boner PO Box 1449 Goodlettsville TN 37070 24265438 0 X N/A X 1985 TN Provide medical benefits for participants. 13 0 0 0 0 0 0 0 18798369 18110956 281431 -7894 41777 22919 19121577 18125981 0 0 21313381 19911923 523 0 0 0 0 1667672 1710900 22981576 21622823 -3859999 -3496842 10499448 8934608 11820162 11387887 -1320714 -2453279 Provide health and welfare benefits to eligible participants. 0 0 19975757 Benefits paid to eligible participants and dependents. 349068 Insurance premium paid for participants and their dependents. -412902 Change in IBNR and hour bank liability. 19911923 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 5 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 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 1053212 Southern Benefit Administrators 2001 Caldwell Drive Goodlettsville TN 37072 Administrative 478319 2 Employer Contributions 525100 16641491 16641491 Reciprocity In 525100 1415194 1415194 Employee Contributions 525100 895885 895885 Reciprocity Out 525100 -841614 -841614 18110956 91913 91913 6039650 6139457 -99807 -99807 -99807 Late Penalties 525100 22919 22919 22919 18125981 18034068 0 91913 19911923 19911923 458121 458121 19317 19317 44638 44638 22862 22862 1004879 1004879 36917 36917 847 847 4848 4848 11868 11868 Payroll Reimbursement 105583 105583 Misc. 1020 1020 21622823 19911923 1710900 0 881541 1238184 573951 2284140 1947622 1875136 38856 0 0 7096334 3498292 10499448 8934608 253212 233839 11566950 11154048 11820162 11387887 X -1320714 -2453279 -1320714 -2453279 10499448 8934608 X -3496842 -97580 2461857 X 0 1 X 1 0 0 Hour Bank Liability 9416906 Claims Payable - IBNR 1737142 11154048 X 18028401 -97580 -97580 18125981 0 18125981 22035725 0 22035725 -412902 -412902 21622823 Part X, Line 2: The trust established to hold the Fund's net assets received an exemption letter from the Internal Revenue Service dated April 5, 1988, stating that the trust is tax-exempt under the provisions of Section 501(c)(9) of the Internal Revenue Code (IRC). In addition, the Fund and the trust are required to operate in conformity with the IRC to maintain the tax-exempt status of the trust. Management believes that the Fund, as amended, is being operated in compliance with the applicable requirements of the IRC and, therefore, believes that the related trust remains tax-exempt. Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken by the Fund and recognize a tax liability (or asset) if it has taken an uncertain position that more likely than not would not be sustained upon examination by the Internal Revenue Service. The Fund is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. Management believes it is no longer subject to income tax examinations for years prior to December 31, 2009. 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 regulary 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. Form 990, Part XI, line 9: Merger - Carp 127 H&W 2,461,857. 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