2022-07-07T12:51:53-05:00 2021-08-31 363168081 SIKICH LLP 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2020-09-01 237422786 WISCONSIN MASONS' HEALTH CARE FUND WISC 8003625474 2901 W BELTLINE HIGHWAY NO 100 MADISON WI 537134226 DAVID HAHN CHAIRMAN 8003625474 2022-07-05 1 DAVID HAHN 999009999 BRIDGETTE MUGGE P00671418 2627549400 2022-07-05 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAVID HAHN 2901 W BELTLINE HIGHWAY NO 100 MADISON WI 537134226 38927444 0 X N/A X 1973 WI TO PROVIDE HEALTH, LIFE, DENTAL, AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS, SPOUSES, AND DEPENDENTS. 19 11 48 11 0 0 0 0 26002011 19098014 659976 1217754 185478 3095858 26847465 23411626 0 0 17092670 13737651 0 0 0 0 0 3896976 3651008 20989646 17388659 5857819 6022967 28387794 30780214 11789519 8645764 16598275 22134450 TO PROVIDE HEALTH, LIFE, DENTAL, AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS, SPOUSES, AND DEPENDENTS. 0 0 TO PROVIDE HEALTH, LIFE, DENTAL, AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS, SPOUSES, AND DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 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 1 0 0 1 4 0 1 48 1 0 0 0 0 0 0 0 0 X 19 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X BENESYS INC 8003625474 2901 W BELTLINE HWY SUITE 100 MADISON WI 537134226 JIM VICK TRUSTEE 1.00 35.00 X 0 102012 71891 WYNN JONES TRUSTEE 1.00 X 0 93876 69291 TOBIN BOYLE TRUSTEE 1.00 35.00 X 0 91480 71044 WILLIAM BONLENDER TRUSTEE 1.00 35.00 X 0 93190 69411 MIKE HYATT TRUSTEE 1.00 35.00 X 0 97039 67514 FELIX RAMIREZ TRUSTEE 1.00 42.00 X 0 86084 73789 DAVID HAHN CHAIRMAN 1.00 2.00 X X 0 0 0 MATT QUASIUS SECRETARY/TREASURER 1.00 X X 0 0 0 JEFF LECKWEE TRUSTEE 1.00 X 0 0 0 JERRY SHEA TRUSTEE 1.00 X 0 0 0 BARRY SCHOLZ TRUSTEE 1.00 X 0 0 0 DAVID BOHL TRUSTEE 1.00 X 0 0 0 JEFF STAVER TRUSTEE 1.00 X 0 0 0 DEAN BASTEN TRUSTEE 1.00 X 0 0 0 LARRY RASCH TRUSTEE 1.00 X 0 0 0 JASON MATTILA TRUSTEE 1.00 X 0 0 0 JOHN TOPP THRU 13121 TRUSTEE 1.00 X 0 0 0 JOHN NESSE 2121 - 71921 TRUSTEE 1.00 X 0 0 0 MATT MARCELLIS FROM 71921 TRUSTEE 1.00 X 0 0 0 PATRICK MCCABE FROM 101220 TRUSTEE 1.00 X 0 95790 67850 ANDREW REED FROM 101220 TRUSTEE 1.00 X 0 93876 69291 0 753347 560081 0 0 1 0 BENEFIT PLAN ADMINISTRATION 2901 WEST BELTLINE HIGHWAY SUITE 1 MADISON WI 53713 CONTRACT ADMINISTRATION 958095 UNITED HEALTHCARE INSURANCE COMPANY PO BOX 88822 MILWAUKEE WI 53228 CLAIMS / PPO EXPENSE 449527 MERCER HEALTH & BENEFITS LLC 155 NORTH WACKER DRIVE STE 1500 CHICAGO IL 60606 CONSULTING 204507 US BANK NATIONAL ASSOCIATION PO BOX 1800 SAINT PAUL MN 55101 BANKING / INVESTMENTS 118122 4 EMPLOYER CONTRIBUTIONS 900099 16603438 16603438 SELF PAY CONTRIBUTIONS 900099 2494576 2494576 19098014 446424 446424 16287148 15515818 771330 771330 771330 CHANGE IN MEMBER DOLLAR BANK 900099 2966155 2966155 SUBROGATION 900099 129621 129621 MISCELLANEOUS 900099 82 82 3095858 23411626 22193872 0 1217754 13737651 838883 160534 52592 296688 108023 31317 13140 9331 HRA REIMBURSEMENTS 771124 PPO SERVICE ADMIN FEES 583489 MEDICARE ADVANTAGE PREM 581253 STOP-LOSS PREMIUMS 161182 43452 17388659 21478 21477 9826925 3987627 3118307 2539367 162098 242832 15258986 23988911 28387794 30780214 233581 336960 26497 26497 11529441 8282307 11789519 8645764 X 0 0 0 0 16598275 22134450 16598275 22134450 28387794 30780214 X 6022967 1426274 -1913066 X 0 1 X 1 0 0 CLAIMS PAYABLE 1410105 HRA LIABILITY 6872202 8282307 X 21819153 1426274 1426274 20392879 52592 2966155 3018747 23411626 14650891 280979 280979 14369912 52592 2966155 3018747 17388659 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE ("IRC"). THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE ("IRS") AND IS THEREFORE NOT SUBJECT TO TAX UNDER PRESENT INCOME TAX LAWS. THE PLAN SPONSOR BELIEVES THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC. U.S. GAAP REQUIRES 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 IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS, HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN MEMBER DOLLAR BANK 2,966,155. PART XII, LINE 2D - OTHER ADJUSTMENTS: INCREASE IN BENEFIT OBLIGATIONS PAYABLE 280,979. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN MEMBER DOLLAR BANK 2,966,155. 0 0 0 JIM VICK TRUSTEE 0 102012 0 0 0 0 0 51611 0 20280 0 173903 0 0 MIKE HYATT TRUSTEE 0 97039 0 0 0 0 0 48149 0 19365 0 164553 0 0 PATRICK MCCABE FROM 101220 TRUSTEE 0 95790 0 0 0 0 0 47570 0 20280 0 163640 0 0 WYNN JONES TRUSTEE 0 93876 0 0 0 0 0 49011 0 20280 0 163167 0 0 ANDREW REED FROM 101220 TRUSTEE 0 93876 0 0 0 0 0 49011 0 20280 0 163167 0 0 WILLIAM BONLENDER TRUSTEE 0 93190 0 0 0 0 0 49131 0 20280 0 162601 0 0 TOBIN BOYLE TRUSTEE 0 91480 0 0 0 0 0 50764 0 20280 0 162524 0 0 FELIX RAMIREZ TRUSTEE 0 86084 0 0 0 0 0 53718 0 20071 0 159873 0 0 FORM 990, SCHEDULE J, PART I LINE 3 THE RELATED ORGANIZATION, OPERATIVE PLASTERERS & CEMENT MASONS LOCAL 599, USES EXECUTIVE BOARD APPROVAL TO ESTABLISH COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11B THE OFFICERS AND ADMINISTRATIVE MANAGER REVIEWS THE FORM 990 WITH THE ACCOUNTANT BEFORE SIGNING AND MAKING A COPY OF THE FORM 990 AVAILABLE FOR ALL TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C THERE ARE ANNUAL TRUSTEE QUESTIONNAIRES. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS -1,913,066. BAC DISTRICT COUNCIL PO BOX 510617 NEW BERLIN WI 53151 391590426 LABOR UNION WI 501(C)(5) 0 BOARD OF TRUSTEES WI MASONS' HEALTH CARE FUND 2901 W BELTLINE HIGHWAY STE 100 MADISON WI 537134226 237422786 JOINT BOARD OF TRUSTEES WI 501(C)(9) 0 MILWAUKEE AREA BRICKLAYERS APPRENTICESHIP TRAINING FUND 17125 W CLEVELAND AVENUE NEW BERLIN WI 531510741 391333915 APPRENTICESHIP TRAINING WI 501(C)(3) 0 OPERATIVE PLASTERERS & CEMENT MASONS LOCAL 599 8701 N LAUER STREET MILWAUKEE WI 53224 391960564 LABOR UNION WI 501(C)(5) 0 HANSON MASONRY & CONCRETE LLOYD HAMM MASONRY MAVID CONSTRUCTION SERVICE LLC WALLY KING MASONRY LLC AGC OF GREATER MILWAUKEE API INC APPLETON LATHING CORP ARNIE MACKEY CONSTRUCTION ARTEAGA CONSTRUCTION INC BANE NELSON BEDROCK FLINT INC BENEFIT PLAN ADMINISTRATOR OF WI BERGHAMMER CORP BOLDT OSCAR CONSTRUCTION CO BORTH-WILSON INC BUKACEK CONSTRUCTION INC C&S CONSTRUCTION INC CAMOSY INC CAPELLE BROTHERS & DIEDRICH INC CASTELLAN TILE & TERRAZZO INC CAULKING PLUS INC CH SCHMIDT INC CLASSIC MARBLE & GRANITE CM MORRIS GROUP INC CONCRETE MASONRY INC CORNERSTONE CONSTRUCTION CROWLEY MASONRY INC D&M MASONRY LLC DAROLD BERGER MASONRY DICKOW & CYZAK TILE DOYLE CONTRACTORS INC EDGAR PRAGER & SONS EXECUTIVE PLASTERING CO FABCON INC FINDORFF & SON INC FOWLER & HAMMER INC FOX VALLEY & CONSTRUCTION G&W PLASTERING INC GAGNON INC GEGARE TILE INC GEORGE SIEGFRIED CONSTRUCTION CO HARBOR CITY MASONRY INC HAROLD ARDNT HEIN WILLIAM CONSTRUCTION INC HETZEL TILE HEULER TILE COMPANY HILLSIDE DAMPROOFING INC HOMBURG CONTRACTORS INC HUNZINGER CONSTRUCTION CO IEI GENERAL CONTRACTORS INC INTERIOR INSTALLATION J&J LEE CONSTRUCTION JAC MASONRY INC JH HASSINGER INC JOHNSON TERRAZZO COMPANY JP CULLEN & SONS INC JUROWSKI RJ CONSTRUCTION INC KENNETH F SULLIVAN INC KMI CONSTRUCTION LLC KOTZE CONSTRUCTION COMPANY INC LEWIS CONSTRUCTION INC LIPPERT TILE CO INC LUNDA CONSTRUCTION MA MORTENSON CO MAAS BROS CONSTRUCTION COMPANY MACCO'S COMMERCIAL INTERIORS MARKET & JOHNSON INC MARTELL CONSTRUCTION MEGAL CONSTRUCTION COMPANY MEYER CR & SONS CO MIDDLETON CONSTRUCTION INC MIRON CONSTRUCTION COMPANY INC MORTL RESTORATIONT NATIONAL MACHINERY PLATT CONSTRUCTION COMPANY POELLINGERS INC PUKALL COMPANY INC QUASIUS BROTHERS INC RASCH CONSTRUCTION & ENGINE REFRACTORY SERVICE INC RESCH'S TILE INC RICE IVAN & SONS RILEY CONSTRUCTION INC ROSSI CONSTRUCTION SCHERRER CONSTRUCTION COMPANY INC SCHLEIS FLOOR COVERING SCHMITT JOSEPH & SONS CO SCIACHITANO CAULKING INC SERVAIS TILE & STONE INC SID'S SEALANTS SMITH CD CONSTRUCTION COMPANY INC STEBBIBS ENGINEERING COMPANY STRETAR MASONRY & CONCRETE STRUCTURAL APPLICATORS INC SUPERIOR MASONRY BUILDERS TRI NORTH BUILDERS INC TRIERWEILER CONSTRUCTION VOGEL BROTHERS BUILDING COMPANY VONASEK & SCHIEFFER INC WALSH MASONRY INC WINKLER MASONRY INC WISCONSIN TERRAZZO TILE INC ZEISE FRANK CONSTRUCTION INC 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, SCHEDULE R, PARTS II-IV IN ADDITION TO THE CONTRIBUTING EMPLOYERS REPORTED AS RELATED ORGANIZATIONS ON SCHEDULE R, PARTS II-IV, THE FUND HAD ADDITIONAL EMPLOYERS THAT HAVE NOT YET RESPONDED TO THE FUNDS EFFORT TO OBTAIN THE TAX CLASSIFICATION. THE CONTRIBUTING EMPLOYERS ARE: AARON KOWALSKI MASONRY LLC, ACOUSTICS ASSOCIATES INC., ALBANY NY #2, B&D ASSOCIATES, BAC LOCAL UNION 15 WELFARE, BADGER WASHING, BARTHENHEIER CONSTRUCTION, BERGLUND CONSTRUCTION, THE CAULKING COMPANY, INC., CEMENT M&P LOCAL 518, CENTRAL ILLINOIS BRICKLAYERS HEALTH, CENTRAL ILLINOIS BRICKLAYERS, CHICAGO MASONRY LOCAL 21, CHICAGO TILE #67, COMMERCIAL FLOORING INSTALLATIONS, CONSTRUCTION & TURNAROUND, CONTRACT TILE & CARPET, COUNTERTOP DESIGNS, CREATIVE ERECTORS, CUTTIN EDGE TILE SERVICE CUTTING, EMPIRE REFRACTORY SERVICES, EMPRESS SURFACE SOLUTIONS, G FONTANA AND SONS, GILLESPIE & POWERS, HEELEIN & SONS 86471, HOUSE OF STONE, ICONIC FINISHES LLC, IMTEF, INTERNATIONAL HEALTH, INTERNATIONAL PENSION, IOWA LABORERS DC HEALTH & WELFARE, JIMMY Z MASONRY, JOHNSON'S CARPET ONE 55807, JT THORPE & SON, JW FLOORING INC, JW SEALANTS, KINGSTON TILE CO., KOCH KNIGHT LLC, LIFE SAFETY SYSTEMS INC., LOCAL 7 TILE INDUSTRY, LOCAL #502 ILLINOIS, MASONRY WELFARE TRUST, MASS BRICKLAYERS, MASTERFOAM INSULATION LLC, MAXIMUM PRECAST, MEL BJURSTROM MASONRY LLC, MICHIGAN BAC HEALTH/PENSION, MN & ND BRICKLAYERS, MR DAVIDS FLOORING INTERNATIONAL, MOUNT HOREB MASONRY, NORTHERN ILL & IOWA LAB, O'CONNOR CONTRACTORS, INC, OHIO BRICKLAYERS, OPCMIA 21046, CONSTRUCTION INDUSTRY, POWERWASHING PROFESSIONALS LLC, QUALITY BUILDING RESTORATION INC., R&T SPECIALISTS, RAY THEOBALD MASONRY CONSTRUCTION, REVOLUTION INDUSTRIAL SERVICES, SCHAEFER GROUP, INC., SEATTLE WASHINGTON #1, SPRAY INSULATIONS, INC., STUCKEY CONSTRUCTION, SWANSON SPRAY SYSTEMS, SYMBIONT CONSTRUCTION, TAPPING TROWEL MASONRY, TVJ MASONRY, INC., TWIN CITY CEMENT MASONS, UNIVERSAL BLASTCO MI TILE, US VET GENERAL CONTRACTING, LLC, VAN MINSEL BROS, WI LABORERS FUND.