2023-11-14T11:29:37-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-01-01 396069788 NORTH CENTRAL STATES REGIONAL COUNCIL OF CARPENTERS' HEALTH FUND NORT 7158353174 PO BOX 4002 EAU CLAIRE WI 54702 ROBERT BARKER CHAIRMAN 7158353174 2023-11-13 1 ROBERT BARKER 999009999 0 DOUGLAS BERTOSSI P00637990 6123764500 2023-11-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ROBERT BARKER PO BOX 4002 EAU CLAIRE WI 54702 108796414 0 X WWW.NCSCBF.COM X 1963 WI TO PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 18 0 0 18 0 0 0 0 70799363 78066797 8446846 4312682 45691 9712 79291900 82389191 0 0 78049082 84253256 842393 793699 0 0 0 1857268 2013266 80748743 87060221 -1456843 -4671030 165171349 139652826 699064 746966 164472285 138905860 TO PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 0 0 PROVIDE SELF FUNDED BENEFITS FOR APPROXIMATELY 5,688 UNION MEMBERS AND THEIR DEPENDENTS. TO PAY FOR INSURANCE PREMIUMS FOR TRANSPLANT COVERAGE FOR MEMBERS AND THEIR DEPENDENTS. 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 1 0 0 0 0 0 0 0 0 0 1 0 0 1 148 0 0 1 0 0 0 0 0 0 0 0 X 18 0 0 0 1 0 0 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X NICOLE SUMMERS 7158353174 PO BOX 4002 EAU CLAIRE WI 54702 PATRICK NILSEN LABOR TRUSTEE 1.00 40.00 X 0 245395 147834 MIKE SHEA MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 ROBERT SIEBEL MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 BARRY SCHOLZ MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 JAMES MARTIN MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 SAM GABRILSKA MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 ERIC BALLWEG MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 DAVE SMESTAD MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 SCOTT WATSON LABOR TRUSTEE 1.00 40.00 X 0 96744 86892 MICHAEL ADAMAVICH LABOR TRUSTEE 1.00 40.00 X 0 104895 89167 PAT RODRIGUEZ LABOR TRUSTEE 1.00 40.00 X 0 123397 98341 CHRIS HILL LABOR TRUSTEE 1.00 40.00 X 0 109234 101341 WAYNE NORDIN LABOR TRUSTEE 1.00 40.00 X 0 160035 116724 COREY BIALCIK LABOR TRUSTEE 1.00 40.00 X 0 135722 102637 BURT JOHNSON TRUSTEE, CHAIRMAN 1.00 40.00 X X 0 173640 126297 ROBERT BARKER TRUSTEE, SECRETARY/TREASUR 1.00 40.00 X X 0 264040 44808 CHUCK SPOEHR LABOR TRUSTEE 1.00 40.00 X 0 101224 86132 SID SAMUELS MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 JOHN RAINES LABOR TRUSTEE 1.00 40.00 X 0 173640 76452 JEFF MCLEAN MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 SEAN CULLEN MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 NICOLE SUMMERS ADMINISTRATIVE MANAGER 16.00 29.00 X 48960 88339 43991 48960 1776305 1120616 0 0 1 0 ANTHEM BLUECROSS BLUESHIELD PO BOX 951254 CLEVELAND OH 44193 CLAIMS PROCESSING 1896282 EXPRESS SCRIPTS 4600 NORTH HANLEY ROAD ST LOUIS MO 63134 CLAIMS PROCESSING 882716 CASE MANAGEMENT SPECIALISTS 553 S INDUSTRIAL DR HARTLAND WI 53209 CONTRACTED MEDICAL CONSULTANT 463495 THE PREVIANT LAW FIRM SC 310 W WISCONSIN AVE STE 100 MW MILWAUKEE WI 53212 LEGAL COUNSEL 295117 DELTA DENTAL 2801 HOOVER ROAD PO BOX 828 STEVENS POINT WI 54481 CLAIMS PROCESSING 224176 7 EMPLOYER CONTRIBUTIONS 525100 69210701 69210701 EMPLOYEE CONTRIBUTIONS 525100 8856096 8856096 78066797 2570245 2570245 28149660 26407223 1742437 1742437 1742437 MISCELLANEOUS 525100 9712 9712 9712 82389191 78066797 0 4322394 84253256 181289 314189 134768 124816 38637 374465 40000 110013 835048 202720 6196 69210 69 31549 19670 48715 EDP MAINT./EDUCATION 231888 PCORI FEE 24173 BANK CHARGES 12695 MISC EXPENSES 2118 4737 87060221 5486091 1847805 5896296 6865378 3704 3622 35574 34191 27268 27268 0 0 86863857 76032017 65510901 52778184 1374926 2091629 165171349 139652826 408864 309866 290200 437100 699064 746966 X 0 0 0 0 164472285 138905860 164472285 138905860 165171349 139652826 -4671030 -20895395 0 X 0 1 X 1 0 27268 27268 0 0 INVESCO INSTITUTIONAL TRUST 21822146 F NTGI DAILY ALL COUNTRY 30956038 F 52778184 RECIPROCITY CONTRIBUTIONS PAYABLE 437100 437100 X 61383783 -20895395 -20895395 82279178 110013 110013 82389191 86950208 0 86950208 110013 110013 87060221 PART X, LINE 2: THE VEBA TRUST FUNDING CERTAIN BENEFITS OF THE FUND RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) DATED JULY 24, 1964, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). HOWEVER, AS A RESULT OF THE FUND'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2021 AND 2020 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE FUND AND TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE FUND ADMINISTRATOR BELIEVES THAT THE FUND IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. 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 IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 PATRICK NILSEN LABOR TRUSTEE 0 245395 0 0 0 0 0 114078 0 33756 0 393229 0 0 ROBERT BARKER TRUSTEE, SECRETARY/TREASUR 0 189096 0 74095 0 849 0 24380 0 20428 0 308848 0 0 BURT JOHNSON TRUSTEE, CHAIRMAN 0 173640 0 0 0 0 0 94495 0 31802 0 299937 0 0 WAYNE NORDIN LABOR TRUSTEE 0 160035 0 0 0 0 0 85603 0 31121 0 276759 0 0 JOHN RAINES LABOR TRUSTEE 0 173640 0 0 0 0 0 60212 0 16240 0 250092 0 0 COREY BIALCIK LABOR TRUSTEE 0 135722 0 0 0 0 0 78226 0 24411 0 238359 0 0 PAT RODRIGUEZ LABOR TRUSTEE 0 123397 0 0 0 0 0 73882 0 24459 0 221738 0 0 CHRIS HILL LABOR TRUSTEE 0 109234 0 0 0 0 0 72192 0 29149 0 210575 0 0 MICHAEL ADAMAVICH LABOR TRUSTEE 0 104895 0 0 0 0 0 66283 0 22884 0 194062 0 0 CHUCK SPOEHR LABOR TRUSTEE 0 101224 0 0 0 0 0 64057 0 22075 0 187356 0 0 SCOTT WATSON LABOR TRUSTEE 0 96744 0 0 0 0 0 64822 0 22070 0 183636 0 0 NICOLE SUMMERS ADMINISTRATIVE MANAGER 48960 88339 0 0 0 0 0 22720 0 21271 48960 132330 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 816 816 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 318 318 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 225 225 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 496 496 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 982 982 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 785 785 0 0 0 3622 FORM 990, PART VI, SECTION A, LINE 4 THE TRUST WAS AMENDED SO THAT A CHAIRMAN AND A SECRETARY-TREASURER SERVE A TERM OF TWO YEARS COMMENCING ON JANUARY 1. THIS IS A CHANGE FROM THE PREVIOUS TERMS, WHERE THE CHAIRMAN AND SECRETARY-TREASURER SERVED FOR A TERM OF ONE YEAR, COMMENCING ON MAY 1. IN ADDITION, THE CHAIRMAN AND SECRETARY-TREASURER FOR ANY COMMITTEE WILL BE ELECTED IN THE SAME MANNER. FORM 990, PART VI, SECTION A, LINE 7A THE ASSOCIATED GENERAL CONTRACTORS OF WISCONSIN, INC. AND THE NORTH CENTRAL STATES REGIONAL COUNCIL OF CARPENTERS (THE BARGAINING PARTIES), BOTH APPOINT 50% OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE ORGANIZATION'S INDEPENDENT PUBLIC ACCOUNTING FIRM BASED ON INFORMATION PROVIDED BY MANAGEMENT. ONCE A DRAFT OF THE FILING IS AVAILABLE, IT IS REVIEWED BY MANAGEMENT AND ANY CHANGES INCORPORATED INTO THE FILING BEFORE BEING PRESENTED TO THE HEALTH BOARD FOR APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES ARE REQUIRED TO COMPLETE AN ANNUAL QUESTIONNAIRE REGARDING ANY POSSIBLE CONFLICTS OF INTEREST. ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST MUST BE DISCLOSED TO THE APPROPRIATE BOARD OR COMMITTEE AND THEY WILL DETERMINE IF A CONFLICT EXISTS AND IF THEY CAN OBTAIN A MORE ADVANTAGEOUS ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT. IF NOT, THE BOARD OR COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF DISINTERESTED TRUSTEES WHETHER THE TRANSACTION IS IN THE FUNDS BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE AND WILL DECIDE WHETHER TO ENTER INTO THE TRANSACTION ON THAT BASIS. IF THE BOARD OR COMMITTEE BELIEVES THAT A TRUSTEE HAS FAILED TO DISCLOSE, IT WILL GIVE THE TRUSTEE AN OPPORTUNITY TO EXPLAIN. IF THE BOARD OR COMMITTEE DETERMINES THE TRUSTEE HAS FAILED TO DISCLOSE, IT WILL TAKE DISCIPLINARY AND CORRECTIVE ACTION. THE TRUSTEE WITH A CONFLICT MUST LEAVE THE MEETING WHILE THE BOARD OR COMMITTEE MAKES THE DECISION WHETHER A CONFLICT EXISTS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. CARPENTERS LU #314 NORTH CENTRAL STATES REG CNCL (BA) NORTH CENTRAL STATES REG CNCL OF CARPS UBC NATIONAL JOB CORPS TRAININ NCSRCC TRAINING FUND 1704 DEVNEY DRIVE ALTOONA WI 54720 391243343 TRAINING BENEFITS WI 501(C)(3) LINE 11 N/A 0 LABOR MGMT COOPERATIVE TRUST OF THE NCSRCC & AGC OF WI INC 1704 DEVNEY DRIVE ALTOONA WI 54720 680572562 DRUG TESTING AND REIMBURSMENT FOR CLASSES WI 501(C)(6) N/A 0 NCSRCC PENSION FUND 1704 DEVNEY DRIVE ALTOONA WI 54720 396079856 PENSION BENEFITS WI 401 (A) N/A 0 NCSRCC SUPPLEMENTAL RETIREMENT PLAN 1704 DEVNEY DRIVE ALTOONA WI 54720 800234499 DEFINED CONTRIBUTIONS BENEFITS WI 401 (A) N/A 0 ACOUSTIC PROFESSIONALS LLC ADVANTAGE INDUSTRIAL SYSTEMS LLC BADGER SCAFFOLD LLC CCF LABOR LLC CECO CONCRETE CONSTRUCTION KRAEMER NORTH AMERICA LLC LIFT TECH SPECIALIST SAFWAY STEEL PRODUCTS LLC - ST PAUL SCHMITT ACOUSTICS LLC SHEET PILING SERVICES LLC U S VET GENERAL CONTRACTING LLC DN TANKS INC HAYES BOILER & MECHANICAL INC JTS BUILDS LLC RHI LLC TWIN CITY TILE & MARBLE CO A K INSTALLATION INC ACOUSTIC SPEC INC CO VANRYZIN - 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