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 046063733 ELECTRICAL WORKERS HEALTH AND WELFARE FUND LOCAL 103 IBEW ELEC 6172885999 256 FREEPORT STREET 2ND FLOOR BOSTON MA 02122 RICHARD P GAMBINO 6172885999 2013-09-13 1 9789751099 2011 2016-02-24 21:20:13Z RICHARD P GAMBINO 256 FREEPORT STREET BOSTON MA 02122 393583633 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 25 0 0 0 0 0 72460201 78964222 5967817 4893803 0 1380000 78428018 85238025 0 0 80310967 68003543 1077075 2093811 0 0 0 4041518 4584855 85429560 74682209 -7001542 10555816 133225742 147515148 10847286 9986361 122378456 137528787 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 0 1 1982 0 1 25 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 JONATHAN WEINSLAW 1.00 X 0 0 0 PAUL GUARRACINO 1.00 X 0 0 0 RICHARD GAMBINO 20.00 X 67919 84709 52673 67919 84709 52673 0 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 2255300 MODERN ASSISTANCE 1458 HANCOCK STREET QUINCY MA 02169 HEALTH CARE ADMINISTRATION 156279 BLACKROCK FINANCIAL MGMT ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 147866 LOOMIS SAYLES ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 143678 INNOVATIVE SOFTWARE SOLUTIONS TWO EXECUTIVE CAMPUS CHERRY HILL NJ 08002 CONSULTING 143292 6 EMPLOYER CONTRIBUTIONS 75344702 75344702 PARTICIPANT SELF-PAYME 3619520 3619520 78964222 2824012 2824012 310415399 308345608 2069791 2069791 2069791 ADMIN EXPENSE REIMBURS 1380000 1380000 1380000 85238025 80344222 0 4893803 68003543 67919 1203612 213453 505189 103638 197248 46305 448959 325512 130505 225163 47492 24701 387267 BCBS ADMINISTRATIVE EXP 2255606 REPAIRS & MAINTENANCE 161788 POSTAGE 139016 BANK CHARGES 63477 131816 74682209 8087329 12150439 3122633 1048449 6609194 7041206 6967 17819 421587 301154 115312 120433 88406649 96807435 22170371 25743746 4707287 4585621 133225742 147515148 347966 169337 10499320 9817024 10847286 9986361 X 122378456 137528787 122378456 137528787 133225742 147515148 X 10555816 4594515 X X 0 1 1 X 0 159623 78035 81588 261964 223119 38845 120433 S&P 500 COMMON TRUST 25743746 F 25743746 DUE TO INVESTMENT ACQUISITIONS 2072657 CONTRACTOR DEPOSITS 384997 DUE TO RELATED PARTIES 720034 BENEFITS CLAIMS PAYABLE 6639336 9817024 85238025 74682209 10555816 4594515 -655295 3939220 14495036 89383581 4594515 4594515 84789066 448959 448959 85238025 74888545 0 74888545 448959 -655295 -206336 74682209 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, 2011, 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: NET CHANGE IN BENEFITS PAYABLE -655,295. PART XIII, LINE 4B - OTHER ADJUSTMENTS: NET CHANGE IN BENEFITS PAYABLE -655,295. X X X 0 0 0 RICHARD GAMBINO 67919 84709 0 0 0 0 16907 0 35766 0 120592 84709 0 0 KAITLYN GAMBINO FAMILY MEMBER OF OFFICER 23791 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 ANNUALLY BASED ON THE EMPLOYMENT CONTRACT IN PLACE AS WELL AS THE REVIEW OF WAGE INFORMATION PROVIDED BY THE LABOR UNION. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,594,515. NET CHANGE IN BENEFITS PAYABLE -655,295. TOTAL TO FORM 990, PART XI, LINE 5: 3,939,220. FORM 990, PART XII, LINE 2C: THE PROCESS DID NOT CHANGE FROM PRIOR YEAR. 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