2013-09-13T12:51:21-05:00 2012-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET STE 140 NORTH ANDOVER MA 01845 990 2011-12-01 042088633 SHEET METAL WORKERS LOCAL UNION NO 17 INSURANCE FUND SHEE 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 ROBERT KEOGH 6174265646 2013-09-13 1 JEANNIE MICKEL P01058630 9789751099 2011 2016-02-24 21:20:13Z ROBERT KEOGH 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 53327610 0 X X 1950 MA TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE PARTICIPANTS 6 6 21 0 0 0 0 0 21084712 22102759 1423527 1355584 371200 377260 22879439 23835603 0 0 21564806 23385826 484195 563444 0 0 0 420709 437583 22469710 24386853 409729 -551250 47438670 49915660 3824507 3839982 43614163 46075678 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 0 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 0 1 2 0 21 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 184735 0 70869 184735 0 70869 1 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 969104 1 EMPLOYER CONTRIBUTIONS 561000 19501302 19501302 SASMI CONTRIBUTIONS 561000 1608927 1608927 MEMBER CONTRIBUTIONS 561000 992530 992530 22102759 740728 740728 30106863 29492007 614856 614856 614856 ADMIN ASSESSMENTS 900099 377260 377260 377260 23835603 23094875 0 740728 23385826 178551 183820 172165 28908 12000 36361 22399 166883 32000 12149 26354 30617 9619 45138 INSURANCE 17777 POSTAGE/PRINTING 10618 TELEPHONE 8225 ADMINISTRATIVE EXPENSE 5868 1575 24386853 250 250 4382544 1976518 3826237 4488302 8020 21119 1151395 386244 791997 765151 36848956 40912067 1580666 1752253 47438670 49915660 578611 601217 3245896 3238765 3824507 3839982 X 0 0 0 0 43614163 46075678 43614163 46075678 47438670 49915660 X -551250 3012765 X 0 1 1 X 0 807660 106958 700702 343735 279286 64449 765151 INCURRED BUT NOT REPORTED CLAIMS 3238765 3238765 23835603 24386853 -551250 1835751 1177014 3012765 2461515 25504471 1835751 1835751 23668720 166883 166883 23835603 24203708 0 24203708 166883 16262 183145 24386853 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012, 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 XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS MERGER WITH SMW LOCAL 17-RI 1,177,014. PART XIII, LINE 4B - OTHER ADJUSTMENTS: NET CHANGE IN BENEFIT OBLIGATIONS 16,262. 0 0 0 ROBERT KEOGH 184735 0 0 0 0 0 0 0 70869 0 255604 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 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,835,751. CHANGE IN BENEFIT OBLIGATIONS MERGER WITH SMW LOCAL 17-RI 1,177,014. TOTAL TO FORM 990, PART XI, LINE 5: 3,012,765. 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