2011-10-17T14:49:34-05:00 2010-11-30 RSM McGladrey Inc 80 City Square Boston MA 021293742 990 2009-12-01 046063733 ELECTRICAL WORKERS HEALTH AND WELFARE FUND LOCAL 103 IBEW ELEC 6172885999 256 FREEPORT STREET DORCHESTER MA 02122 Richard Gambino 6172885999 2011-10-17 1 Lynne Johnson 6179129000 2009 2016-03-07 17:11:31Z richard gambino 256 FREEPORT STREET DORCHESTER MA 02122 72553963 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 60522068 64179149 4415259 8374814 0 64937327 72553963 0 70026292 74060870 1955709 1929844 0 0 3037951 3073257 75019952 79063971 -10082625 -6510008 138526769 131686792 2628131 1734028 135898638 129952764 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 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 1 2058 0 24 1 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 X richard gambino 6172885999 256 freeport street dorchester MA 02112 john dumas 1.00 X 0 0 0 charles monahan 1.00 X 0 0 0 Paul guaracino 1.00 X 0 0 0 glenn kingsbury 1.00 X 0 0 0 johnathan wineslaw 1.00 X 0 0 0 michael monahan 1.00 X 0 0 0 richard gambino 20.00 X 56295 95853 44928 56295 95853 44928 0 0 1 0 blue cross blue shield 401 park drive 14 boston MA 02215 health claim admin 2454522 modern assistance 1458 hancock street 3 quincy MA 02169 health care admin 156279 loomis investments 1 financial center boston MA 02111 investment management 141239 blackrock financial management 55 east 52nd street new york NY 10055 investment management 123041 4 contractor contributio 900099 63096418 63096418 participant self-pmts 900099 1082731 1082731 64179149 4385150 4385150 3989664 3989664 3989664 3989664 72553963 64179149 0 8374814 74060870 1101998 250142 472214 105490 183050 96156 328496 257558 252361 217468 52913 34609 264444 administrative expenses 1074522 equipment rental and re 171374 bank fees 103897 vehicle expenses 10502 dues & subscriptions 6000 19907 79063971 687094 1153313 10454436 9856056 5421788 6848280 21148 21704 865267 734851 160501 130416 99097239 89585398 20306457 22335023 2378106 1756602 138526769 131686792 288398 472987 2339733 1261041 2628131 1734028 X 135898638 129952764 135898638 129952764 138526769 131686792 X 0 1 1 X 0 135778 64208 71570 729489 670643 58846 130416 state street global advisors 22335023 F 22335023 DUE TO INVESTMENT ACQUISITIONS 281946 CONTRACTOR DEPOSITS 574353 DUE TO HEALTHCARE SERVICE PROVIDER 332966 due to related parties 71776 1261041 72553963 79063971 -6510008 564134 564134 -5945874 72789601 564134 -328496 235638 72553963 0 72553963 78735475 0 78735475 328496 328496 79063971 Part X: Description of Uncertain Tax Positions Under FIN 48: 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 Internal Revenue Service ("IRS"). the plan administrator has analyzed the tax positions taken by the plan, and has concluded that as of november 30, 2010, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or an asset) or disclosure in the financial statements. the plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. the plan administrator believes it is no longer subject to income tax examinations for years prior to 2006. Part XII, Line 2d - Other Adjustments: investment expense included in revenue per audited financial statements: -328496. Part XIII, Line 4b - Other Adjustments: investment expense included in revenue per audited financial statements: 328496. X X X 0 0 0 richard gambino 56295 95853 0 0 0 0 5608 22726 3319 13275 65222 131854 0 0 kaitlyn gambino see schedule o 11391 see sch. o 0 haley gambino see schedule o 11381 see sch. o 0 Form 990, Part VI, Section B, line 11 a draft version of the form 990 is reviewed by the administrator, Chief Financial Officer, and controller. once the form is finalized, 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 although there is no actual written conflict of interest policy in place, the officers and trustees are required to disclose annually interests that could give rise to conflict. Form 990, Part VI, Section B, line 15a the compensation of the organization's officers are 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. in addition, the form 990 is availabe via guidstar. Form 990, Part Xi, Line 2c: the organization has a committee that assumes responsibly for oversight of the audit of its financial statements and selection of an independent accountant. this process has not changed from prior year. schedule L, part iv, business transactions involving interested persons: (a) name of person: kaitlyn gambino (b) relationship between interested person and organization: family member of richard gambino, an officer of the organization (c) amount of transaction: $11,391 (d) description of transaction: employment (e) sharing of organization revenues? = NO (a) name of person: haley gambino (b) relationship between interested person and organization: family member of richard gambino, an officer of the organization (c) amount of transaction: $11,381 (d) description of transaction: employment (e) sharing of organization revenues? = NO electrical workers pension plan local 103 ibew 256 freeport street dorchester MA 02122 046063734 benefit plan MA N/A electrical workers deferred income fund local 103 ibew 256 freeport street dorchester MA 02122 042471895 benefit plan MA N/A electrical industry labor management cooperation trust 256 freeport street dorchester MA 02122 043398237 labor organization MA 501(c)(5) N/A local 103 ibew general fund 256 freeport street dorchester MA 02122 041472080 labor union MA 501(c)(5) N/A 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0