2012-09-14T09:51:18-05:00 2011-11-30 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET STE 140 NORTH ANDOVER MA 01845 990 2010-12-01 042088633 SHEET METAL WORKERS LOCAL UNION NO 17 INSURANCE FUND SHEE 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 ROBERT KEOGH 6174265646 2012-08-31 1 JEANNIE MICKEL 9789751099 2010 2016-02-24 21:20:13Z ROBERT KEOGH 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 52075022 0 X X 1950 MA TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE PARTICIPANTS 6 6 25 0 0 0 0 0 19108295 21084712 1725165 1423527 296460 371200 21129920 22879439 0 0 21092407 21564806 501220 484195 0 0 0 391266 420709 21984893 22469710 -854973 409729 47180107 47438670 4026061 3824507 43154046 43614163 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 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 0 0 0 0 1 2 0 25 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 172364 0 67519 172364 0 67519 1 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 992491 1 EMPLOYER CONTRIBUTIONS 561000 18728406 18728406 SASMI CONTRIBUTIONS 561000 1401818 1401818 MEMBER CONTRIBUTIONS 561000 954488 954488 21084712 1096471 1096471 29522639 29195583 327056 327056 327056 ADMIN ASSESSMENTS 900099 371200 371200 371200 22879439 21084712 0 1794727 21564806 168911 148827 143483 22974 5857 17728 166426 56400 11282 26889 30895 4171 49561 INSURANCE 20860 POSTAGE/PRINTING 13820 TELEPHONE 9411 ADMINISTRATIVE EXPENSE 5469 DUES 1940 22469710 391 250 490178 4382544 2936607 3826237 30648 8020 1157025 365028 839079 791997 41288287 36848956 1594917 1580666 47180107 47438670 719732 578611 3306329 3245896 4026061 3824507 X 0 0 0 0 43154046 43614163 43154046 43614163 47180107 47438670 X 409729 50388 X X 0 1 1 X 0 807660 86249 721411 349365 278779 70586 791997 INCURRED BUT NOT REPORTED CLAIMS 3245896 3245896 22879439 22469710 409729 50388 -147479 -97091 312638 22763401 50388 50388 22713013 166426 166426 22879439 22450763 0 22450763 166426 -147479 18947 22469710 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: CHANGE IN BENEFIT OBLIGATIONS -147,479. PART XIII, LINE 4B - OTHER ADJUSTMENTS: NET CHANGE IN BENEFIT OBLIGATIONS -147,479. 0 0 0 ROBERT KEOGH 172364 0 0 0 0 0 67519 0 0 0 239883 0 165724 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: 50,388. ORGANIZATION HAS NOT CHANGED PROCESS OF REVIEW FROM PRIOR YEAR