2018-05-31T16:19:44-05:00 2017-08-31 470900880 CALIBRE CPA GROUP PLLC 230 W Monroe Street CHICAGO IL 60606 990 2016-09-01 237009055 WISCONSIN LABORERS' HEALTH FUND WISC 6088461742 4633 LIUNA WAY No 201 DEFOREST WI 535322514 john schmitt Trustee 6088461742 2018-05-31 1 COREY BILKEY P00499751 3126550037 2016 2022-09-23 18:48:47Z 4633 LIUNA WAY No 201 DEFOREST WI 535322514 105989445 0 X N/A X 1967 WI TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN. 14 5 193 0 0 0 0 0 83150788 85053358 3022983 2822229 0 0 86173771 87875587 0 0 84069170 86103348 47799 47436 0 0 0 6298005 6658978 90414974 92809762 -4241203 -4934175 265978905 289426056 44835943 54964674 221142962 234461382 X TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN. 0 0 THE PLAN PROVIDES HOSPITAL, MEDICAL, SURGICAL, DENTAL, VISION, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, DISABILITY, AND SKILLED NURSING CARE BENEFITS TO ALL ELIGIBLE PARTICIPANTS. THE PLAN PROVIDES HOSPITAL,MEDICAL, SURGICAL, DENTAL, VISION, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, DISABILITY, AND SKILLED NURSING CARE BENEFITS TO ALL ELIGIBLE PARTICIPANTS. 0 0 0 0 0 0 0 0 0 0 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 0 0 193 1 0 0 0 0 0 0 X 14 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 X benefit plan administrators 6088461742 4633 LIUNA WAY SUITE 201 DEFOREST WI 535322514 MARY WILCOX Trustee 3.00 X 0 0 0 WILLIAM KENNEDY Trustee 3.00 X 0 0 0 THOMAS PTACIN Trustee 3.00 X 0 0 0 BRIAN HORNUNG Trustee 3.00 X 0 0 0 ROBERT BARKER Trustee 3.00 40.00 X 0 193661 29481 JOHN TOPP Trustee 3.00 40.00 X 0 173950 19580 KEVIN LEE former trustee 3.00 3.00 X 0 6320 1560 TONY NEIRA Trustee 3.00 50.00 X 0 135325 74069 JEFF DEHNHOFF Trustee 3.00 40.00 X 0 90481 60923 CLARK JENSEN Trustee 3.00 40.00 X 0 83647 56936 TONY MARCELLE Trustee 3.00 40.00 X 0 87232 38837 JOHN SCHMITT Trustee 3.00 40.00 X 0 146398 78126 DAVE SMESTAD Trustee 3.00 X 0 0 0 DAN BURKE Trustee 3.00 40.00 X 0 96812 66602 KENT MILLER TRustee 3.00 40.00 X 0 88411 56145 0 1102237 482259 0 0 1 0 ANTHEM BLUE CROSS BLUE SHIELD PO BOX 34210 LOUISVILLE KY 40233 PPO SERVICE FEES 2051454 ZENITH AMERICAN SOLUTIONS 4633 LIUNA WAY SUITE 201 DEFOREST WI 53532 ADMIN 1843678 DELTA DENTAL INSURANCE 2801 HOOVER ROAD PO BOX 828 STEVENS POINT WI 54481 DENTAL CLAIMS ADMINISTRATOR 223434 PREVIANT GOLDBERG UELMEN GRATZ MILLE PO BOX 12993 MILWAUKEE WI 53212 LEGAL SERVICES 180338 ULLICO TRUST FUND ADVISORS 1625 Eye Street NW WASHINGTON DC 20006 INV MANAGER 147404 6 EMPLOYER CONTRIBUTIONS 900099 77359122 77359122 SELF-PAY CONTRIBUTIONS 900099 7267710 7267710 SUBROGATION 900099 415039 415039 LIQUIDATED DAMAGES 900099 11487 11487 85053358 2559326 2559326 18376761 18113858 262903 262903 262903 87875587 85053358 0 2822229 86103348 47436 1799001 301289 64763 1110518 2680627 316394 78192 1064 29434 ACA FEES AND ASSESSMENT 277696 92809762 9393222 22652412 768148 1136800 9883361 9359033 6516 17014 46491945 46874899 199080861 209040616 354852 345282 265978905 289426056 2821646 5038643 42014297 49926031 44835943 54964674 X 0 0 0 0 221142962 234461382 221142962 234461382 265978905 289426056 -4934175 18252595 0 X X 0 1 X 1 0 0 COMMON COLLECTIVE TRUSTS 97906743 F POOLED SEPARATE ACCOUNTS 11614269 F LIMITED PARTNERSHIPS 55674529 F 103-12 INVESTMENT ENTITY 24455000 F REAL ESTATE INVESTMENT TRUST 19390075 F 209040616 EST FOR EXTENDED ELIG 36500000 EST FOR INCUR BUT NOT RPTD 9462200 EST FOR BANKED HOURS 160000 ACCUM BALANCE IN PART HSA ACCTS 3803831 49926031 X 105017664 18252595 18252595 86765069 1110518 1110518 87875587 81862601 0 81862601 1110518 9836643 10947161 92809762 Part X, Line 2: AS OF AUGUST 31, 2017, THERE WERE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD IN PROGRESS. AT AUGUST 31, 2017 THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED AUGUST 31, 2014. Part XII, Line 4b - Other Adjustments: INCREASE IN INBR 3,031,500. INCREASE IN ACCUM ELIGIBILITY 3,500,000. INCREASE IN CLAIMS PAYABLE 1,891,319. DECREASE IN BANKED HOURS -80,000. INCREASE IN PART HSA ACCUM BALANCE 1,493,824. 0 0 0 ROBERT BARKER Trustee 0 158661 0 35000 0 0 0 17628 0 11853 0 223142 0 0 JOHN TOPP Trustee 0 173950 0 0 0 0 0 19580 0 0 0 193530 0 0 TONY NEIRA Trustee 0 135325 0 0 0 0 0 57325 0 16744 0 209394 0 0 JEFF DEHNHOFF Trustee 0 90481 0 0 0 0 0 41667 0 19256 0 151404 0 0 JOHN SCHMITT Trustee 0 143795 0 2603 0 0 0 61246 0 16880 0 224524 0 0 DAN BURKE Trustee 0 95458 0 1354 0 0 0 45362 0 21240 0 163414 0 0 Form 990, Part VI, Section B, line 11b THE TRUSTEES AUTHORIZE THE FUND'S THIRD PARTY ADMINISTRATOR AND A DESIGNATED TRUSTEE TO REVIEW THE FORM 990 BEFORE IT IS FILED. Form 990, Part VI, Section B, line 12c THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND HAVE A FIDUCIARY RESPONSIBILITY UNDER ERISA TO ADMINISTER THE PLAN IN THE BEST INTEREST OF THE MEMBERSHIP. THE US DEPARTMENT OF LABOR REQUIRES ALL LABOR TRUSTEES TO REPORT ON FORM LM-30 POTENTIAL SITUATIONS WHERE THERE MAY BE CONFLICTS OF INTEREST. THIS INFORMATION IS OPEN TO THE PUBLIC. Form 990, Part VI, Section C, line 19 A SUMMARY ANNUAL REPORT IS DISTRIBUTED TO ALL PARTICIPANTS. PARTICIPANTS ARE ABLE TO REQUEST THE AUDITOR'S REPORT AND OTHER FINANCIAL INFORMATION FROM THE PLAN ADMINISTRATOR AND/OR DEPARTMENT OF LABOR. ALSO, THE FORM 5500 IS OPEN TO PUBLIC INSPECTION. Form 990, Part XII, line 2c: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. WISCONSIN LABORERS PENSION FUND 4633 LIUNA WAY SUITE 201 DEFOREST WI 53532 396198530 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS WI 401 A 0 WISCONSIN LABORERS APPR & TRAINING FUND 4633 LIUNA WAY 100 DEFOREST WI 53532 391161160 TO PROVIDE TRAINING AND IMPROVE THE SKILLS OF MEMBERS WI 501C 3 0 LABORERS UNION LOCAL #464 1438 n stoughton rd madison WI 53714 390189279 improve condition of workers WI 501c5 0 LABORERS UNION LOCAL 113 6310 w appleton ave milwaukee WI 53210 390367985 improve condition of workers WI 501c5 0 LABORERS UNION LOCAL 140 2771 george st lacrosse WI 54603 390367733 improve condition of workers WI 501c5 0 LABORERS UNION LOCAL 330 886 w airport rd menasha WI 54952 201169193 improve condition of workers WI 501c5 0 LABORERS UNION-LOCAL 268 2233 birch st eau claire WI 54703 562460681 improve condition of workers WI 501c5 0 WIS LABORERS DISTRICT COUNC 4633 LIUNA WAY 100 DEFOREST WI 53532 391142477 improve condition of workers WI 501C5 0 WISCONSIN LABORERS LECET 4633 LIUNA WAY 100 DEFOREST WI 53532 391705116 improved labor mgmt cooperation WI 501c5 0 agc of wisconsin 4814 e broadway madison WI 53716 390712400 improved labor mgmt cooperation WI 501c6 0 allied construction employers assn 17100 w bluemound rd brookfield WI 53005 390189310 improved labor mgmt cooperation WI 501c6 0 A - 1 EXCAVATING INC AL LTDLANDSCAPING AWOAKES & SON INC ABCO BUILDING CORP ACME FIREPROOFING & INS ADKINS CONSTRUCTION INC ADVANCE BOILER & TANK CO LLC AHERN CO ALBERICI CONSTRUCTORS INC ALBRIGHTSON EXCAVATING INC ALFREDSON BROS CONST AMERICAN MASONRY REST CORP AMERICAN SEWER SERV AMES CONSTRUCTION INC ANTHONY INC J P AP COM POWER INC API APPALACHIAN PIPELINE CONTRACTO ARBOR EARTH & STONE LLC ARBOR GREEN INC ARNDT INC HAROLD E ARNIE MACKEY CONST INC ARROW-CRETE CONSTRUCTION ARTEAGA CONSTRUCTION INC ASBESTROL INC ASC INSULATION & FIREPROOFING ASSOC PIPELINE CONSTRUCTION IN ASSOCIATED GENERAL CONTRACTORS AUGELLI CONCRETE & EXCAVAT LLC AZCO INC B & D CONTRACTORS B K B 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