2022-09-13T12:27:23-05:00 2021-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2020-12-01 042088633 SHEET METAL WORKERS LOCAL UNION NO 17 INSURANCE FUND SHEE 6174265646 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 RICHARD KEOGH FUND ADMINISTRATOR 6174265646 2022-09-09 1 RICHARD KEOGH 999009999 JEANNIE MICKEL P01058630 9789751099 2 AAL1 IAL1 2020 2023-04-26 12:10:37Z RICHARD KEOGH 1157 ADAMS STREET 1ST FLOOR DORCHESTER MA 02124 47356839 0 X N/A X 1950 MA TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE PARTICIPANTS 6 6 36 0 0 0 0 0 36656214 45795761 792404 600216 727329 893185 38175947 47289162 0 0 33764559 37141786 911212 911429 0 0 0 696470 715600 35372241 38768815 2803706 8520347 71089053 86646775 4397140 5554005 66691913 81092770 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 0 0 TO PROVIDE HEALTH AND OTHER SPECIFIED BENEFITS TO ELIGIBLE MEMBERS/DEPENDENTS THROUGH A COLLECTIVELY BARGAINED MULTIEMPLOYER 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 0 0 0 0 0 0 0 1 0 0 1 3 0 1 36 1 0 0 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 X JAMES WOOL TRUSTEE 10.00 X X 0 0 0 KEVIN GILL TRUSTEE 10.00 X X 0 0 0 JOSEPH CULLEN TRUSTEE 10.00 X X 0 0 0 JACK DESMOND TRUSTEE 10.00 X X 0 0 0 RICHARD KEOGH TRUSTEE 10.00 X 0 0 0 ROBERT BUTLER TRUSTEE 10.00 X 0 0 0 ROBERT KEOGH ADMINISTRATOR 40.00 X 290000 0 128658 290000 0 128658 1 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 1202859 ELIXIR SOLUTIONS 2181 E AURORA ROAD TWINSBURG OH 44087 PRESCRIPTION CLAIMS ADMINSTRATION 121536 DELTA DENTAL 465 MEDOFRD STREET BOSTON MA 02129 DENTAL CLAIMS ADMINISTRATION 117045 3 EMPLOYER CONTRIBUTIONS 561000 42790549 42790549 MEMBER CONTRIBUTIONS 561000 1500464 1500464 COBRA SUBSIDY CONTRIBUTIONS 561000 1244067 1244067 SASMI CONTRIBUTIONS 561000 260681 260681 45795761 656989 656989 10904 67677 -56773 -56773 -56773 ADMIN ASSESSMENTS 900099 711624 711624 PPP LOAN FORGIVENESS 900099 129330 129330 DELINQUENT CONTRACTOR INTEREST 900099 48356 48356 3875 3875 893185 47289162 46632173 0 656989 37141786 268389 250950 242673 143520 5897 17267 29050 134298 57265 10956 64387 33081 9182 36967 28546 STOPLOSS INSURANCE 249667 TELEPHONE 14204 ACA FEES 12509 POSTAGE 9037 9184 38768815 3584694 1780773 6018571 7765561 75455 58943 1241928 672099 593282 569829 57993151 73643169 2823900 2828500 71089053 86646775 283952 416000 4113188 5138005 4397140 5554005 X 0 0 0 0 66691913 81092770 66691913 81092770 71089053 86646775 8520347 5880510 0 X X 0 1 X 1 0 810927 293595 517332 431001 378504 52497 569829 LONGVIEW LARGECAP 500 25644880 F INSTITUTIONAL SENIOR LOAN FUND 5078259 F BAIRD INTERMEDIATE BOND 23483312 F NHIT CORE PLUS DISCRETION TRUST 14782755 F US REAL ESTATE INVEST FUND 4653963 F 73643169 INCURRED BUT NOT REPORTED CLAIMS 4697995 BENEFITS PAYABLE 409686 DUE TO AFFILIATES 30324 5138005 X 53035374 5880510 5880510 47154864 134298 134298 47289162 37640024 0 37640024 134298 994493 1128791 38768815 PART X, LINE 2: 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, 2021, 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 XII, LINE 4B - OTHER ADJUSTMENTS: NET CHANGE IN BENEFIT OBLIGATIONS 994,493. X 0 0 0 ROBERT KEOGH ADMINISTRATOR 290000 0 0 0 0 0 99954 0 28704 0 418658 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 11B 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 FORM 990, PART XII, LINE 2C: NO CHANGE IN OVERSIGHT PROCESS OR SELECTION OF INDEPENDENT ACCOUNTANT. 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