2016-08-09T12:30:52-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2015-01-01 396069788 NORTH CENTRAL STATES REGIONAL COUNCIL OF CARPENTERS' HEALTH FUND NORT 7158353174 PO BOX 4002 EAU CLAIRE WI 54702 BOB BARKER CHAIRMAN 7158353174 2016-08-05 1 DOUGLAS BERTOSSI P00637990 6123764500 2015 2016-12-15 16:53:06Z BOB BARKER PO BOX 4002 EAU CLAIRE WI 54702 118437352 0 X WWW.NCSCBF.COM X 1963 WI TO PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 18 0 93 18 0 0 0 0 57387326 59456811 8229987 4759610 11241 12696 65628554 64229117 0 0 57648222 61803497 940445 954658 0 0 0 1910102 1402713 60498769 64160868 5129785 68249 199937034 185233047 43382188 33912046 156554846 151321001 TO PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 0 0 PROVIDE SELF FUNDED BENEFITS FOR APPROXIMATELY 5,118 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 1 723 0 93 1 0 0 0 0 0 0 X 18 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X KRISTIN PASSINEAU 7158353174 PO BOX 4002 EAU CLAIRE WI 54702 CHRIS HILL TRUSTEE 1.00 40.00 X 0 106408 38721 BURT JOHNSON TRUSTEE 1.00 40.00 X 0 153542 42510 BOB BARKER TRUSTEE, CHAIRMAN 1.00 40.00 X X 0 205000 30460 F WILLIAM HARVAT TRUSTEE 1.00 40.00 X 0 0 0 BRAD DEPREZ TRUSTEE 1.00 40.00 X 0 0 0 BARRY SCHOLZ TRUSTEE 1.00 40.00 X 0 0 0 JOHN RAINES TRUSTEE, SECRETARY/TREASURER 1.00 40.00 X X 0 250648 46375 JEFF MCLEAN TRUSTEE 1.00 40.00 X 0 0 0 SID SAMUELS TRUSTEE 1.00 40.00 X 0 0 0 WAYNE NORDIN TRUSTEE 1.00 40.00 X 0 106408 38870 SCOTT WATSON TRUSTEE 1.00 40.00 X 0 95845 34647 JERRY SHEA TRUSTEE 1.00 40.00 X 0 0 0 ERIC BALLWEG TRUSTEE 1.00 40.00 X 0 0 0 DAVE SMESTAD TRUSTEE 1.00 40.00 X 0 0 0 PAT NILSEN TRUSTEE 1.00 40.00 X 0 153570 42593 JOE MROTEK TRUSTEE 1.00 40.00 X 0 103946 37525 GERALD YARIE TRUSTEE 1.00 40.00 X 0 103946 76811 PAT RODRIGUEZ TRUSTEE 1.00 40.00 X 0 107870 40690 COREY BIALCIK TRUSTEE 1.00 14.00 X 0 28988 183 KRISTIN PASSINEAU ADMINISTRATIVE MANAGER 17.00 28.00 X 0 128716 37598 0 1544887 466983 0 0 1 0 ANTHEM BLUECROSS BLUESHIELD PO BOX 951254 CLEVELAND OH 44193 CLAIMS PROCESSING 1348151 CASE MANAGEMENT SPECIALISTS 4615 VETTELSON ROAD HARTLAND WI 53209 CLAIMS REVIEW 329458 THE PREVIANT 1555 NORTH RIVER CENTER DRIVE SUIT MILWAUKEE WI 53212 LEGAL 190245 DELTA DENTAL 2801 HOOVER ROAD PO BOX 828 STEVENS POINT WI 54481 CLAIMS PROCESSING 178337 DEARBORN PARTNERS LLC 200 WEST MADISON SUITE 1450 CHICAGO IL 60606 INVESTMENT MANAGER 119157 5 CONTRIBUTIONS 525100 59456811 59456811 59456811 4007889 4007889 54959956 54208235 751721 751721 751721 MISCELLANEOUS 525100 12696 12696 12696 64229117 59456811 0 4772306 61803497 608215 157436 143752 45255 252370 33500 218637 447709 194027 12790 69204 871 43202 14928 37441 PCORI FEES 20336 EDP MAINT./EDUCATION 17499 BANK CHARGES 17211 CLAIMS OFFICE EXPENSES 15168 7820 64160868 5146911 6988517 3374438 3930716 67462 37584 28786 28316 32221 29920 3129 2301 165744278 149473457 24761698 24094873 810332 677283 199937034 185233047 666310 343299 42715878 33568747 43382188 33912046 X 0 0 0 0 156554846 151321001 156554846 151321001 199937034 185233047 68249 -5302094 0 X 0 1 X 1 0 32221 29920 2301 2301 NTGI-QM COMMON S&P 500 EQUITY INDEX FUND- NON LENDING 24094873 F 24094873 DUE TO BROKERS FOR SECURITIES LENDING 33568747 33568747 X 58708386 -5302094 -5302094 64010480 218637 218637 64229117 63942231 0 63942231 218637 218637 64160868 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 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. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2012. X 0 0 0 BURT JOHNSON TRUSTEE 0 153542 0 0 0 0 0 0 0 42510 0 196052 0 0 BOB BARKER TRUSTEE, CHAIRMAN 0 205000 0 0 0 0 0 0 0 30460 0 235460 0 0 JOHN RAINES TRUSTEE, SECRETARY/TREASURER 0 250648 0 0 0 0 0 0 0 46375 0 297023 0 0 PAT NILSEN TRUSTEE 0 153570 0 0 0 0 0 0 0 42593 0 196163 0 0 GERALD YARIE TRUSTEE 0 103946 0 0 0 0 0 0 0 76811 0 180757 0 0 KRISTIN PASSINEAU ADMINISTRATIVE MANAGER 0 128716 0 0 0 0 0 0 0 37598 0 166314 0 0 CONSTRUCTIVE SYSTEMS CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 17 17 0 0 0 DECORATING UNLIMITED CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 6503 6503 0 0 0 GLIDEWELL THERRIEN CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 2533 2533 0 0 0 GREAT LAKES SPECIALTY CONTRACTORS CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 7596 7596 0 0 0 HETZEL-SANFILIPPO INC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 223 223 0 0 0 HOLSTER CONSTRUCTION INC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 4882 4882 0 0 0 JFK BUILDERS INC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 5085 5085 0 0 0 MIDWEST FLOORING OF MADISON CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 2200 2200 0 0 0 NEW FLOORING SERVICES LLC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 4200 4200 0 0 0 R & T SPECIALISTS INC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 252 252 0 0 0 RESHETAR SYSTEMS INC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 151 151 0 0 0 C G SCHMIDT INC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 53 53 0 0 0 STONE CREEK CONTRACTORS CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 116 116 0 0 0 URBAN CONSTRUCTION ADMINISTRATION INC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 3717 3717 0 0 0 WARMKA CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 56 56 0 0 0 37584 FORM 990, PART VI, SECTION A, LINE 7A THE BARGAINING ORGANIZATIONS, THE EMPLOYER AND UNION, BOTH APPOINT 50% OF THE BOARD. 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 11 FORM 990 IS REVIEWED BY ADMINISTRATIVE STAFF AND PRESENTED TO THE HEALTH BOARD OF TRUSTEES 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 B, LINE 15A ADMINISTRATIVE MANAGER WAGES ARE DETERMINED BY THE EXECUTIVE COMMITTEE AND APPROVED BY THE FULL BOARD. BALANCE OF FUND OFFICE STAFF ARE RECOMMENDED BY THE ADMINISTRATIVE MANAGER, REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE AND PRESENT TO THE FULL BOARD FOR APPROVAL AT EACH QUARTERLY MEETING. THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2015. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. 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