2018-06-21T09:16:28-04:00 2017-09-30 382284921 BENDA GRACE STULZ & COMPANY PC 38800 VAN DYKE AVE STE 100 STERLING HEIGHTS MI 48312 990 2016-10-01 382026006 LABORERS METROPOLITAN DETROIT HEALTH AND WELFARE FUND LABO 5173217502 6525 CENTURION DRIVE LANSING MI 48917 WILLIAM BASS CHAIRMAN 5173217502 2018-01-12 BRYAN STULZ P00265596 5868836240 2018-06-21 2016 2022-09-23 18:48:47Z WILLIAM BASS 37734626 false X N/A X 1973 MI PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PLAN PARTICIPANTS. 12 4 0 0 0 24744902 27010614 443208 1156136 350446 236462 25538556 28403212 0 23482906 21264556 0 0 0 2284126 2462704 25767032 23727260 -228476 4675952 44433846 53637752 9029757 11053447 35404089 42584305 PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PLAN PARTICIPANTS. false false TO PROVIDE HOSPITALIZATION, MEDICAL, DEATH, SURGICAL AND OTHER RELATED HEALTH CARE BENEFITS TO ELIGIBLE PLAN PARTICIPANTS. false false false false false false false false false false false false false true false true false false false false false false false false false false false false true false false false false false false false false false false false true false false true 4 0 0 false false false false false false X 12 4 true false false false false true false true true false false false false false false false false false X TIC INTERNATIONAL CORP 5173217502 6525 CENTURION DRIVE LANSING MI 48917 X ALEX ZUREK TRUSTEE 1.00 40.00 X 0 165387 32503 WILLIAM BASS CHAIRMAN 1.00 40.00 X 0 154834 36784 PAUL GASSEL TRUSTEE 1.00 40.00 X 0 150734 37084 MICHAEL AARON TRUSTEE 1.00 40.00 X 0 150244 48058 MARK PULICE TRUSTEE 1.00 40.00 X 0 149308 46738 JASON CHWALEK TRUSTEE 1.00 40.00 X 0 117723 36784 CHARLES WILSON TRUSTEE 1.00 40.00 X 0 0 0 ROBERT COPPERSMITH SECRETARY 1.00 0.00 X 0 0 0 JEREMY ZELLER TRUSTEE 1.00 0.00 X 0 0 0 DAVID KRUSE TRUSTEE 1.00 40.00 X 0 0 0 SCOTT FISHER TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL P SMITH TRUSTEE 1.00 0.00 X 0 0 0 888230 237951 false true false BLUE CROSS BLUE SHIELD OF MICHIGAN 27000 WEST 11 MILE ROAD B494 SOUTHFIELD MI 48034 HEALTH ADMIN 1296938 TIC INTERNATIONAL CORPORATION 6525 CENTURION DRIVE LANSING MI 48917 TPA 421913 LABORERS' JOINT DELINQ COMMITTEE 22260 HAGGERTY ROAD SUITE 350 NORTHVILLE MI 48167 COLLECTION FEES 192987 EAGLE CAPITAL MANAGEMENT 449 PARK AVENUE 17TH FLOOR NEW YORK NY 10022 INVESTMENT MGMT 127282 LEGGHIO & ISRAEL PC 306 S WASHINGTON AVENUE ROYAL OAK MI 48067 LEGAL 116914 5 EMPLOYER CONTRIBUTIONS 230000 21038889 21038889 PARTICIPANT SELF-PAYMENTS 230000 5971725 5971725 27010614 763501 763501 9724049 9331414 392635 392635 392635 MEDICARE PART D SUBSIDY 900099 221168 221168 LIQUIDATED DAMAGES 900099 11432 11432 MISCELLANEOUS 900099 3862 3862 236462 28403212 27639711 763501 21264556 1682134 116914 23500 247541 208007 85987 2335 14980 LBRS NTL HLTH & SFTY DUES 66751 ERISA REPORTING COSTS 12900 EDUCATIONAL FOUNDATION 1655 23727260 0 0 0 3565300 3722931 1019988 2508221 2494068 2694333 986481 990839 36368009 43721428 44433846 53637752 1622757 2112447 7407000 8941000 9029757 11053447 X 35404089 42584305 35404089 42584305 44433846 53637752 4675952 2504264 X false true X true false ACCUMULATED ELIGIBILITY CREDITS 7514000 CLAIMS INCURRED BUT NOT REPORTED 1427000 8941000 30659935 2504264 2504264 28155671 247541 247541 28403212 23479719 23479719 247541 247541 23727260 false false false ALEX ZUREK TRUSTEE 165387 32503 197890 WILLIAM BASS CHAIRMAN 154834 36784 191618 PAUL GASSEL TRUSTEE 150734 37084 187818 MICHAEL AARON TRUSTEE 150244 48058 198302 MARK PULICE TRUSTEE 149308 46738 196046 JASON CHWALEK TRUSTEE 117723 36784 154507 FORM 990, PART VI LINE 2 - FAMILY RELATIONSHIP OR BUSINESS RELATIONSHIP - THE RELATIONSHIP BETWEEN THE TRUSTEES OF THE FUND IS A "BUSINESS RELATIONSHIP". THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED. THE FUND, AS A TAFT-HARTLEY TRUST FUND, IS ADMINISTERED BY A BOARD OF TRUSTEES WHICH IS COMPOSED OF AN EQUAL NUMBER OF UNION AND EMPLOYER REPRESENTATIVES. BECAUSE OF THIS ORGANIZATIONAL REQUIREMENT THRERE IS A "BUSINESS RELATIONSHIP" BETWEEN THE TRUSTEES. LINE 12 - ANNUALLY, EACH TRUSTEE MUST ANSWER THE FIDUCIARY LIABILITY INSURANCE RENEWAL QUESTIONAIRE, WHICH CONTAINS QUESTIONS REGARDING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST. LINE 15 - THE FUND DID NOT HAVE A CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICAL, OR OTHER OFFICERS OR KEY EMPLOYEES, AS THOSE TERMS ARE DEFINED IN THE INSTRUCTIONS. FORM 990, PAGE 6, PART VI, LINE 7A TRUSTEES ARE APPOINTED BY SPONSORING PARTIES OF THE TRUST. UNION TRUSTEES ARE APPOINTED BY PERSONS AUTHORIZED BY THE EACH APPOINTING UNION ORGANIZATON'S EXECUTIVE BOARD, WHO ARE ELECTED PERIODICALLY BY MEMBERS IN GOOD STANDING WHO ARE ELEGIBLE TO VOTE CONSISTENT WITH THE CONSTITUTION OF THE APPOINTING UNION ORGANIZATION. EMPLOYER TRUSTEES ARE APPOINTED BY PERSONS AUTHORIZED BY THEIR EXECUTIVE BOARDS, WHO ARE ELECTED CONSISTENT WITH THE VOTING REQUIREMENTS OF EACH SPECIFIC EMPLOYER ASSOCIATION. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PRESENTED AND APPROVED AT A MEETING OF THE BOARD OF TRUSTEES, SUBJECT TO REVEIW BY AND APPROVAL OF THE FUND'S LEGAL COUNSEL. IN ADDITION, EACH TRUSTEE IS PROVIDED WITH A COMPLETED COPY OF THE FUND'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES), AS ULTIMATELY FILED WITH THE IRS. FORM 990, PAGE 6, PART VI, LINE 19 THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED. IT OPERATES IN COMPLIANCE WITH THE REPORTING AND DISCLOSURE REQUIREMENTS OF SUBTITLE B, PART I ERISA WITH RESPECT TO DISCLOSURE OF ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION. IT OPERATES IN COMPLIANCE WITH THE FIDUCIARY RESPONSIBILITY REQUIREMENTS OF SUBTITLE B, PART 4 OF ERISA. FORM 990, PART VII LINE 1A - MICHAEL AARON, MARK PULICE, BILL BASS, PAUL GASSEL, JASON CHWALEK, AND ALEX ZUREK ALL SERVED AS TRUSTEES OF THE FUND WITHOUT COMPENSATION FROM THE FUND FOR THOSE SERVICES. HOWEVER, THEY WERE COMPENSATED AS EMPLOYEES OF EITHER LABORERS LOCAL 1076 OR 1191, OR MICHIGAN LABORERS DISTRICT COUNCIL, ALL OF WHICH WERE CONTRIBUTING EMPLOYERS TO THE FUND AND, AS SUCH, "RELATED ORGAINZATIONS" AS THAT TERM IS DEFINED IN THE INSTRUCTIONS. 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