2025-11-17T09:34:38-06:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2024-01-01 396069788 NORTH CENTRAL STATES REGIONAL COUNCIL OF CARPENTERS' HEALTH FUND NORT 7158353174 PO BOX 4002 EAU CLAIRE WI 54702 DEREK ALLEN CHAIRMAN 7158353174 2025-11-13 1 0 DOUGLAS BERTOSSI P00637990 6123764500 2025-11-12 2024 2025-03-06 01:10:19Z DEREK ALLEN PO BOX 4002 EAU CLAIRE WI 54702 148577905 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 84977423 86177033 2626403 10534686 82578 19318 87686404 96731037 0 0 97534992 102251047 0 0 0 0 0 3249917 3579967 100784909 105831014 -13098505 -9099977 135714913 129099345 540385 1079566 135174528 128019779 TO PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 0 0 PROVIDE SELF FUNDED BENEFITS FOR APPROXIMATELY 5,949 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 0 0 0 0 1 1 0 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 67 0 1 0 0 0 0 0 0 0 0 0 X 18 0 0 1 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X ERIN IVES 7157528509 PO BOX 4002 EAU CLAIRE WI 54702 PATRICK NILSEN LABOR TRUSTEE 1.00 60.00 X 0 338371 174081 MIKE SHEA 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 45.00 X 0 142481 94471 MICHAEL ADAMAVICH LABOR TRUSTEE 1.00 48.00 X 0 159526 102422 PAT RODRIGUEZ LABOR TRUSTEE 1.00 51.00 X 0 176109 111335 WAYNE NORDIN LABOR TRUSTEE 1.00 55.00 X 0 219926 137012 COREY BIALCIK LABOR TRUSTEE 1.00 60.00 X 0 96333 65104 BURT JOHNSON LABOR TRUSTEE, SECRETARY/TREASURER 1.00 55.00 X X 0 233933 137255 SID SAMUELS MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 DAVID COENEN LABOR TRUSTEE 1.00 50.00 X 0 184806 111883 APOLONIO DURAN LABOR TRUSTEE 1.00 45.00 X 0 144956 95090 KEVIN HENNESSEY LABOR TRUSTEE 1.00 45.00 X 0 142498 94485 DEREK ALLEN MANAGEMENT TRUSTEE, CHARIMAN 1.00 40.00 X X 0 0 0 ALLISON KNAUTZ MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 ROBERT SEIBEL MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 JOHN WAGNER MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 BOB BARKER MANAGEMENT TRUSTEE 1.00 40.00 X 0 289756 46172 0 2128695 1169310 0 0 1 0 ANTHEM BLUECROSS BLUESHIELD 3075 VANDERCAR WAY CINCINNATI OH 45209 CLAIMS PROCESSING 2073253 WILSON-MCSHANE CORPORATION 3001 METRO DR STE 500 BLOOMINGTON MN 54481 ADMINISTRATOR 1811013 EXPRESS SCRIPTS 4600 NORTH HANLEY ROAD ST LOUIS MO 63134 CLAIMS PROCESSING 1203241 CASE MANAGEMENT SPECIALISTS INC 553 S INDUSTRIAL DR HARTLAND WI 53029 CONTRACTED MEDICAL CONSULTANT 638616 TEAM 3001 METRO DR STE 500 BLOOMINGTON MN 54481 EMPLOYEE ASSISTANCE PROGRAM 362452 7 EMPLOYER CONTRIBUTIONS 525100 77321682 77321682 EMPLOYEE CONTRIBUTIONS 525100 8855351 8855351 86177033 3648485 3648485 58733069 51846868 6886201 6886201 6886201 EMPLOYER INTEREST 525100 19208 19208 INVEST CLASS ACTIONS 525100 110 110 19318 96731037 86196351 0 10534686 102251047 1787803 260587 44914 127542 1149144 98389 24764 31597 PCORI FEE 28520 BANK CHARGES 10099 MISC EXPENSES 7778 SPD EXPENSE 4532 4298 105831014 3504606 120106288 7624260 6921071 6240 4529 51506 62911 69358778 52969468 2200055 2004546 135714913 129099345 176785 729766 363600 349800 540385 1079566 X 0 0 0 0 135174528 128019779 135174528 128019779 135714913 129099345 -9099977 1945228 0 X 0 0 0 0 RECIPROCITY CONTRIBUTIONS PAYABLE 349800 349800 X 98548723 1945228 1945228 96603495 127542 127542 96731037 105703472 0 105703472 127542 127542 105831014 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 2024 AND 2023 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 338371 0 0 0 0 0 135935 0 38146 0 512452 0 0 BURT JOHNSON LABOR TRUSTEE, SECRETARY/TREASURER 0 233933 0 0 0 0 0 102288 0 34967 0 371188 0 0 WAYNE NORDIN LABOR TRUSTEE 0 219926 0 0 0 0 0 102045 0 34967 0 356938 0 0 BOB BARKER MANAGEMENT TRUSTEE 0 205076 0 82970 0 1710 0 24191 0 21981 0 335928 0 0 DAVID COENEN LABOR TRUSTEE 0 184806 0 0 0 0 0 84846 0 27037 0 296689 0 0 PAT RODRIGUEZ LABOR TRUSTEE 0 176109 0 0 0 0 0 83796 0 27539 0 287444 0 0 MICHAEL ADAMAVICH LABOR TRUSTEE 0 159526 0 0 0 0 0 76599 0 25823 0 261948 0 0 APOLONIO DURAN LABOR TRUSTEE 0 144956 0 0 0 0 0 70656 0 24434 0 240046 0 0 KEVIN HENNESSEY LABOR TRUSTEE 0 142498 0 0 0 0 0 70045 0 24440 0 236983 0 0 SCOTT WATSON LABOR TRUSTEE 0 142481 0 0 0 0 0 70037 0 24434 0 236952 0 0 COREY BIALCIK LABOR TRUSTEE 0 96333 0 0 0 0 0 49239 0 15865 0 161437 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 398 398 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 155 155 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 1591 1591 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 292 292 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 46 46 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 109 109 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 658 658 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 2 2 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 479 479 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 593 593 0 0 0 SUBSTANTIAL CONTRIBUTOR CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 206 206 0 0 0 4529 FORM 990, PART VI, SECTION A, LINE 3 WILSON MCSHANE CORPORATION PERFORMS CONTRIBUTION COLLECTION, PAYROLL AUDIT AND BOOKKEEPING SERVICES FOR THE NORTH CENTRAL STATES REGIONAL COUNCIL OF CARPENTERS' HEALTH FUND. THERE ARE NO OFFICERS OR TRUSTEES COMPENSATED BY THE SERVICE ORGANIZATION FOR THE SERVICES PROVIDED TO THE PLAN. 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. 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