2012-09-17T14:30:10-05:00 2011-11-30 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET STE 140 NORTH ANDOVER MA 01845 990 2010-12-01 046063733 ELECTRICAL WORKERS HEALTH AND WELFARE FUND LOCAL 103 IBEW ELEC 6172885999 256 FREEPORT STREET BOSTON MA 02122 RICHARD GAMBINO 6172885999 2012-09-17 1 9789751099 2010 2016-02-24 21:20:13Z RICHARD GAMBINO 256 FREEPORT STREET BOSTON MA 02122 413521605 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 24 0 0 0 0 0 64179149 72460201 8374814 5967817 0 0 72553963 78428018 0 0 74060870 80310967 1929844 1077075 0 0 0 3073257 4041518 79063971 85429560 -6510008 -7001542 131686792 133225742 1734028 10847286 129952764 122378456 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 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 1956 0 24 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 GAMBINO 6172885999 256 FREEPORT STREET 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 45187 67919 84709 45187 0 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 2284844 LOOMIS SAYLES ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 180303 SEGAL ROITMAN LLP 111 DEVONSHIRE STREET BOSTON MA 02109 LEGAL SERVICES 171550 MODERN ASSISTANCE 1458 HANCOCK STREET QUINCY MA 02169 HEALTH CARE ADMINISTRATION 156279 THE SEGAL COMPANY 116 HUNTINGTON AVENUE BOSTON MA 02116 ACTUARIAL SERVICES 154775 6 EMPLOYER CONTRIBUTIONS 71717288 71717288 PARTICIPANT SELF-PAYME 742913 742913 72460201 3660266 3660266 337401138 335093587 2307551 2307551 2307551 78428018 72460201 0 5967817 80310967 67919 556529 92380 306547 53700 107615 101040 368635 345854 44917 151473 7769 14768 350411 BCBS ADMINISTRATIVE EXP 2298823 REPAIRS & MAINTENANCE 83089 POSTAGE 63001 BANK CHARGES 33609 PRINTING 28656 41858 85429560 1153313 8087329 9856056 3122633 6848280 6609194 21704 6967 391765 276453 130416 115312 89585398 88406649 22335023 22170371 1756602 4707287 131686792 133225742 472987 347966 1261041 10499320 1734028 10847286 X 129952764 122378456 129952764 122378456 131686792 133225742 X -7001542 -572766 X X 0 1 1 X 0 135779 73030 62749 255986 203423 52563 115312 S&P 500 COMMON TRUST 22170371 F 22170371 DUE TO INVESTMENT ACQUISITIONS 1746866 CONTRACTOR DEPOSITS 454196 DUE TO RELATED PARTIES 1003627 BENEFITS CLAIMS PAYABLE 7294631 10499320 78428018 85429560 -7001542 -572766 7294631 6721865 -279677 77486617 -572766 -572766 78059383 368635 368635 78428018 77766294 0 77766294 368635 7294631 7663266 85429560 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 7,294,631. PART XIII, LINE 4B - OTHER ADJUSTMENTS: NET CHANGE IN BENEFITS PAYABLE 7,294,631. X X X 0 0 0 RICHARD GAMBINO 67919 84709 0 0 0 0 5874 22142 3615 13556 77408 120407 0 0 KAITLYN GAMBINO FAMILY MEMBER OF OFFICER 23791 COMPENSATION 0 HALEY GAMBINO FAMILY MEMBER OF OFFICER 15831 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 LOSSES ON INVESTMENTS: -572,766. THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT, THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ELECTRICAL WORKERS PENSION PLAN LOCAL 103 IBEW 256 FREEPORT STREET BOSTON MA 02122 046063734 BENEFIT PLAN MA 0 ELECTRICAL WORKERS DEFERRED INCOME FUND LOCAL 103 IBEW 256 FREEPORT STREET BOSTON MA 02122 042471895 BENEFIT PLAN MA 0 ELECTRICAL INDUSTRY LABOR MANAGEMENT COOPERATION TRUST 256 FREEPORT STREET BOSTON MA 02122 043398237 LABOR ORGANIZATION MA 501(C)(5) 0 LOCAL 103 IBEW GENERAL FUND 256 FREEPORT STREET BOSTON MA 02122 041472080 LABOR UNION MA 501(C)(5) 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0