2021-07-07T11:07:11-05:00 2020-11-30 043508036 MANZI & ASSOCIATES LLC 855 TURNPIKE STREET NORTH ANDOVER MA 01845 990 2019-12-01 046063733 HEALTH AND WELFARE TRUST FUND LOCAL 103 IBEW HEAL 6172885999 256 FREEPORT STREET BOSTON MA 02122 MICHAEL P DONOVAN FUND ADMINISTRATOR 6172885999 2021-07-01 1 JEANNIE MICKEL P01058630 9789751099 2019 2022-09-23 18:48:47Z MICHAEL P DONOVAN 256 FREEPORT STREET BOSTON MA 02122 263437520 0 X WWW.TRUSTFUNDS103.COM 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 150368555 123682706 12380987 13136670 1824000 1742484 164573542 138561860 0 0 121109596 114264144 2186379 2244432 0 0 0 2576988 2344756 125872963 118853332 38700579 19708528 420279849 457405915 20480570 18470158 399799279 438935757 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 0 0 0 0 0 0 0 1 0 0 1 168 0 1 24 1 0 0 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 MICHAEL P DONOVAN 6172885999 256 FREEPORT STREET 2ND FLOOR BOSTON MA 02122 LOU ANTONELLIS TRUSTEE 1.00 X 0 0 0 RICHARD ANTONELLIS TRUSTEE 1.00 X 0 0 0 ROBERT SHEEHAN JR TRUSTEE 1.00 X 0 0 0 BILL WEBER TRUSTEE 1.00 X 0 0 0 ALAN SCHARFE TRUSTEE 1.00 X 0 0 0 MICHAEL MCDONALD TRUSTEE 1.00 X 0 0 0 MICHAEL DONOVAN FUND ADMINISTRATOR 22.00 33.00 X 89329 133994 65482 JOSHUA WOOD CONTROLLER 10.60 29.40 X 32957 91410 57430 122286 225404 122912 0 0 1 0 BLUE CROSS BLUE SHIELD 401 PARK DRIVE BOSTON MA 02215 HEALTH CLAIMS ADMINISTRATION 2720897 DELTA DENTAL 46 MEDFORD STREET BOSTON MA 02129 HEALTH CARE ADMINISTRATION 367246 LOOMIS SAYLES ONE FINANCIAL CENTER BOSTON MA 02111 INVESTMENT MANAGEMENT 315706 MODERN ASSISTANCE 1458 HANCOCK STREET QUINCY MA 02169 HEALTH CARE ADMINISTRATION 286669 THE SEGAL COMPANY 116 HUNTINGTON AVE BOSTON MA 02116 INCONSULTANT 245047 9 EMPLOYER CONTRIBUTIONS 119624407 119624407 PARTICIPANT SELF-PAYMENTS 4058299 4058299 123682706 6587311 6587311 131425019 124875660 6549359 6549359 6549359 ADMIN EXPENSE REIMBURSEMENTS 1722000 1722000 OTHER INCOME 20484 20484 1742484 138561860 125425190 0 13136670 114264144 216497 1100728 320414 518549 88244 172840 43775 881788 233538 128491 228826 25817 43278 76780 REPAIRS & MAINTENANCE 294242 POSTAGE 91846 EQUIPMENT LEASES 46564 PCORI FEES 32329 44642 118853332 11300626 16718367 33906161 26174658 14463636 10749275 50729 222690 1207083 648411 561104 558672 248692141 274051817 108574662 126346721 2730790 2583715 420279849 457405915 227336 219431 20253234 18250727 20480570 18470158 X 399799279 438935757 399799279 438935757 420279849 457405915 19708528 19427950 0 X X 0 1 X 1 0 677748 190612 487136 473389 446610 26779 55946 11189 44757 558672 S&P 500 COMMON TRUST 90806505 F BGO DIVERSIFIED US PROPERTY FUND LP-CLASS B 35540216 F 126346721 DUE TO INVESTMENT ACQUISITIONS 1456136 CONTRACTOR DEPOSITS 360524 DUE TO RELATED PARTIES 2252594 BENEFITS CLAIMS PAYABLE 14181473 18250727 X 157108022 19427950 19427950 137680072 881788 881788 138561860 115093578 0 115093578 881788 2877966 3759754 118853332 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, 2020, 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 BENEFITS PAYABLE 2,877,966. X X X 0 0 0 MICHAEL DONOVAN FUND ADMINISTRATOR 89329 133994 0 0 0 0 43018 0 22464 0 154811 133994 0 0 JOSHUA WOOD CONTROLLER 32957 91410 0 0 0 0 34966 0 22464 0 90387 91410 0 0 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT VERSION OF THE FORM 990 IS REVIEWED BY THE FUND ADMINISTRATOR, 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. 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. FORM 990, PART XII, LINE 2C: THE PROCESS DID NOT CHANGE FROM PRIOR YEAR. 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