2014-01-14T11:55:44-06:00 2013-05-31 470900880 CALIBRE CPA GROUP PLLC 566 WEST LAKE STREET SUITE 300 CHICAGO IL 606611414 990 2012-06-01 237166771 OPERATING ENGINEERS LOCAL 139 HEALTH BENEFIT FUND OPER 2625499190 PO BOX 160 PEWAUKEE WI 530720130 Richard Wanta 2625499190 2014-01-10 1 Andy Hein P00499757 3126550037 2012 2015-11-30 17:44:51Z Richard Wanta PO BOX 160 PEWAUKEE WI 530720130 265717145 0 X N/A X 1970 WI TO PROVIDED HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN. 10 10 63 0 0 0 0 0 100976503 97981315 9492515 12320224 0 0 110469018 110301539 0 0 91898723 92729240 0 0 0 0 0 5521743 5742227 97420466 98471467 13048552 11830072 252427353 279367253 31033548 35883749 221393805 243483504 X TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN 0 0 THE PLAN PROVIDES MEDICAL, DENTAL, VISION, LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. THE PLAN PROVIDES MEDICAL, DENTAL, VISION, LIFE, AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 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 2544 0 1 63 1 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X CARDAY ASSOCIATES 2625499190 N27 W23233 ROUNDY DRIVE PEWAUKEE WI 530720130 TERRY MCGOWAN 3.00 40.00 X 0 163025 58190 TOM WOLF 3.00 X 0 0 0 RYAN OEHLHOF 3.00 40.00 X 0 132579 58190 DAN SPERBERG 3.00 40.00 X 0 75024 5623 CHARLES BOWEN 3.00 X 0 0 0 TIM PETERSON 3.00 X 0 0 0 JOHN TOPP 3.00 40.00 X 0 139000 8100 RICHARD WANTA 3.00 40.00 X 0 44240 0 DAVID BOHL 3.00 40.00 X 0 108241 21079 STEVE BUFFALO 3.00 40.00 X 0 109561 58190 MARY JANE DEBATTISTA 3.00 X 0 0 0 CHARLES WARNER 3.00 40.00 X 0 121907 54560 0 893577 263932 0 0 1 0 ANTHEMBCBS 4361 IRWIN SIMPSON RD MASON OH 45040 PPO ACCESS AND ADMIN 1845621 CARDAY ASSOCIATES INC N27 W23233 ROUNDY DR PEWAUKEE WI 53072 THIRD PARTY ADMIN 1480534 CASE MANAGEMENT SPECIALISTS INC PO BOX 102 NASHOTAH WI 53058 CONSULTING FEES 370998 CVS CAREMARK 2211 SANDERS ROAD NBT-5 NORTHBROOK IL 60062 RX ADMIN FEE 289057 COMPSYCH 455 N CITYFRONT PLAZA DRIVE CHICAGO IL 60611 MENTAL HEALTH SER 237489 9 EMPLOYER CONTRIBUTIONS 900099 81972813 81972813 SELF-PAY CONTRIBUTIONS 900099 13537862 13537862 MEDICARE SUBSIDY 900099 998589 998589 SUBROGATION RECOVERIES 900099 941806 941806 ERRP SUBSIDY 900099 530245 530245 97981315 9370104 9370104 158365726 155415606 2950120 2950120 2950120 110301539 97981315 0 12320224 92729240 1633108 144004 25724 377836 3040602 67975 156002 184524 21372 59311 31769 98471467 4128735 3019876 11043723 10681438 42872 47939 1369553 1161609 247739 207944 235057234 258341054 4991580 1907050 2077422 252427353 279367253 541571 418177 255024 281726 30236953 35183846 31033548 35883749 X 0 0 0 0 221393805 243483504 221393805 243483504 252427353 279367253 11830072 10259626 0 X X 0 1 X 1 0 985234 935729 49505 384319 225880 158439 207944 CLAIMS PAYABLE 2519900 CLAIMS INCURRED BUT NOT REPORTED 10079800 ACCUM PART HEALTH SAV ACCOUNTS 22584146 35183846 X 120183329 10259626 10259626 109923703 377836 377836 110301539 93146738 0 93146738 377836 4946893 5324729 98471467 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The trust established under the Plan to hold the Plan's assets is qualified pursuant to Section 501(c) 9 of the Internal Revenue Code as a tax-exempt organization. The Plan has obtained a favorable tax determination letter from the Internal Revenue Service, and the Plan sponsor believes that the Plan, as amended, continues to qualify and to operate in accordance with applicable provisions of the Internal Revenue Code. 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 (or asset) if the organization has taken an uncertain position that more likely than not would not be sustained upon examination by the taxing authorities. As of May 31, 2013, 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 taxing jurisdictions; however, there are currently no audits for any tax periods in progress. At May 31, 2013, the Plan is no longer subject to income tax examinations for years prior to the fiscal year ended May 31, 2010. Part XII, Line 4b - Other Adjustments: INC IN PART. ACCUM HEALTH REIMB ACCOUNTS INC IN EST CLAIMS INCURRED BUT NOT RPTD INC IN EST CLAIMS PAYABLE 0 0 0 TERRY MCGOWAN 0 162237 0 0 0 788 0 34400 0 23790 0 221215 0 0 RYAN OEHLHOF 0 131982 0 0 0 597 0 34400 0 23790 0 190769 0 0 STEVE BUFFALO 0 109304 0 0 0 257 0 34400 0 23790 0 167751 0 0 CHARLES WARNER 0 121476 0 0 0 431 0 32600 0 21960 0 176467 0 0 Form 990, Part VI, Section A, line 3 Line 3 explanation - IN ACCORDANCE WITH THE PLAN'S TRUST AGREEMENT, THE TRUSTEES HAVE CONTRACTED THE SERVICES OF A THRID PARTY ADMINISTRATOR, CARDAY ASSOCIATES. THE THIRD PARTY ADMINISTRATOR, UNDER THE DIRECTION OF THE TRUSTEES, ADMINISTERS THE OFFICES OF THE TRUST FUND. Form 990, Part VI, Section B, line 11 THE BOARD OF TRUSTEES HAVE AUTHORIZED DESIGNATED TRUSTEES (THE CHAIRMAN AND/OR SECRETARY TRESURER) TO REVIEW THE FORM 990 PRIOR TO FILING. A COPY OF THE FILED RETURN IS MADE AVAILABLE TO ALL TRUSTEES TO REVIEW SUBSEQUENT TO FILING. Form 990, Part VI, Section B, line 12c THE ACTIONS OF THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND ERISA. BOTH ESTABLISH STANDARDS OF CONDUCT FOR PLAN FIDUCIARIES. THE TRUSTEES ARE REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST TO THE ENTIRE BOARD. 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 THE U.S. DEPARTMENT OF LABOR. ALSO, FORM 5500 IS OPEN TO PUBLIC INSPECTION THROUGH THE U.S. DEPARTMENT OF LABOR. FORM 990, PART XII, LINE 2C - EXPLANATION NO CHANGE FROM PRIOR YEAR. Wis Oper Eng Skill Improvement & Apprent N27W23233 ROUNDY DR PO Box 160 PEWAUKEE WI 53072 391102559 TRAINING FUND WI 501(c)(3) Line_2_School_Descri 0 LMCT of Operating Engineers Local 139 N27W23233 ROUNDY DR PO Box 160 PEWAUKEE WI 53072 364656562 INDUSTRY ADVANCEMENT FUND WI 501(c)(5) 0 Allied Const Emp Assn 17100 W BLUEMOUND RD 102 BROOKFIELD WI 53005 390189310 CONTRACTORS ASSOCIATION WI 501(c)(6) 0 Construction Bus Group 4702 S BILTMORE LN MADISON WI 53718 391703979 INDUSTRY ADVANCEMENT FUND WI 501(c)(5) 0 Intl UN Oper Eng 139 N27W23233 ROUNDY DR PEWAUKEE WI 53072 390368025 LABOR UNION WI 501(c)(5) 0 WI Undergrd Contr As 2835 NORTH MAYFAIR RD MILWAUKEE WI 53222 390745462 CONTRACTORS ASSOCIATION WI 501(c)(6) 0 Associated General Contractors of Wisconsin 4814 EAST BROADWAY MADISON WI 53716 390712400 CONTRACTORS ASSOCIATION WI 501(c)(6) 0 Wisconsin Transportation Builders Association Inc 1 S PINCKNEY ST NO 300 MADISON WI 53703 390138120 CONTRACTORS ASSOCIATION WI 501(c)(6) 0 Augelli Concrete Exc LLC Blaq Excavating LLC C & C Drilling LLC Corevac LLC Cornerstone Pavers LLC Cornerstone Plbg LLC Countryside Woods LLC Dahn Constr Co LLC Dane County Contracting LLC Firstar Eq Co LLC Graham & Associates LLC Grube Const Co LLC GJ Hawk Constr LLC Iverson Construction LLC J&J Underground LLC JI Construction LLC KG Landscaping LLC Kraemer Co LLC Minda LLC Morrow Equip Comp LLC Precision PL LLC Pro Scapes Landscaping LLC Red Flint SandGravel LLC Ridgway LLC dba Price Erecting RMI Worldwide LLC Rock Solid Concrete Pmpg LLC Roof Vac Pkus LLC Rubloff Excavation LLC Senft & Sons LLC Paul G Sopinski Trenching & Exc LLC Surf Prep Hwy Sves LLC Total Excavating LLC Toys Custom Shearing LLC UPI LLC Vslley Hydro Exc LLC Valley Mach & Iron LLC Vista Design & Constr LLC WP Grading LLC A & B WeldingConstr A & N Lenox Dirt Works Inc A-1 Excavating Acme Concrete Paving Inc Adirondack Services Adkins Constr Inc Ahern J F Co AJM Contractors Inc Albrightson Excavating Inc Alliance Constructors Alliance Steel Const American Asphalt-WI American Demoltn Corp American Grading Inc American Sewer Sve Ames Const Inc Amon Company Anderson Excavating Andrew Excavating Co Antigo Const Inc Apcompower Inc API Construction Co Appleton LandscpExc Arbor Green Landscape Area Erectors Inc Arnt Constr Co Inc Arrow Crete Constr Ashland Const Co Inc Atlantic Plt Maint Azarian Wrecking Co Azco Inc Babcock & Wilcox Co Bacco Const Co Badger Crane & Dragline Inc Badger Daylighting Corp Badger Environmental Badger Lighting & Signs Badger Swimming Pools Badgerland Demo & Earthwork Bane Nelson Inc Barnhart Crane & Rigging Bartel Exc Inc Baumhardt Aggrgt JJ Baumhardt Sand & Gravel BCF Construction Corp BCI Benavides Constr Bechtel Corporation Bedrock Sewer & Water Best Erectors Biehl Excavating Inc Bigge Crane & Rigging Co Black Diamond Group Inc Blackhawk Fdn Co Bohmann & Vick Inc The Boldt Co Bore Master Inc Brandenburg Ind Serv Brennan Co JF Brennan Co JM Brown County Constructors The Bruce Co Inc Burbach Inc DC Buteyn Peterson Const Co Inc C & W Trucking Calnin & Goss Inc Capitol Sand & Gr Co Capitol Underground Carday Associates Case Foundation Co Casper Constr In Cattell Inc Ray P Ceco Concrete Corp Central Ready Mix Certified Inc Champion Environmental Charps Welding Chippewa Concrete Choice Constr Co Inc Christiansen Roof CJ Drilling Inc Concrete & Masonry Concrete Pump Factory Concrete Structures Construction Risk Mngmnt Contract Dewater Sve Contracting & Material Co Cornelius Contr Corp Coulee Crane Sve Ltd CPR Inc Creative Ent Crn Rntl Inc Cretex S&GJW Peters Cullen & Sons Inc JP Cusatis Constr Inc Custer Exc D & D Welding DB Leasing DK Contractors Inc Dawes Rig & CR Ser Day & Zimmermann NPS Inc De Noble & Sons Scott De Santis Exc Debelak PlbgHtg Co Inc Joe Deconstruction Inc Dekeyser Const Co Denoble SW Constr Inc Joe Di-Mar Construction Dillett Mech Svs Inc Doine Exc Inc Dolson Inc Doniver Inc Doral Corporation Duffek Sand & Gravel Dun Transportation Dykstra Bros Exc Inc Earth Augering Serv EBI Drilling Edgerton Contractors EJM Pipe Sves Inc Equip Services of WI Ericksons Inc Falcon DrillgBlastg Farmer Inc Paul V Fencing Plus Findorff & Son JH Finndrell Co Foundation Service Corp Four Star Const Inc Four Way Const of WI Fox Trking & Exc Inc Leo J Frank Bros Const Fraser Const Co Fraser Shipyard Inc Frattalone Exc & Grading F Gabes Const Co Inc Gallagher Asphalt Corp Gasser Construction DL Gauthier & Son Const Geeding Constr Inc Genesee Aggregate Co Gerke Excavating Gersek Inc Ed GFH Gillen Co Edward E Gillen Foundations Inc Globe Cont Inc Golden Company Inc Graycor Companies Great Lakes Excavating Griffin Construction Griffin Dewatering Grunau Co Inc Gullickson Inc Tom Gulseth Construction Kip Gundlach Champiom Inc Gyr Excavating L & H H & H Utilities Haessly & Haessly Hammersley Stone Hassinger Inc JH Hayden Murphy Equip Co Hayward Baker HC Directional Drilling Heavy & Hwy Exc Hegg Contractors Inc Hein Const Co Inc WM Hein Reclamation Constr Helmkamp Constr Hengel Brothers Inc Hennes Trucking Highway Landscapers Inc Highway Technologies Hoffman Const Co Homburg Const Co Homer Tree Service Hooper Constr Corp Hoover Construction Huml Contractors Inc Huston Co Inc RG Ideal Crane Rntl Inc Illinois Mining Corp Immel Inc Howard Indianhead Pipeline Services Industrial Constr Specialists Infrasource Underground Constr Int'l Industrial Contr Corp Integrity Grading & Exc Intercon Const Inc International Erectr Interstate Improvement Interstate Tree Landscape Intl Chimney Co Intren Inc Iowa Grant Trkg Inc Iverson Const Inc Jackson Geothermal Jamar Co James & Sons Inc Jensen & Son Inc C Jensen Constr Co Jr Jurowski Constr Co RJ KBC Inc KBS Construction Kenny Shea Joint Venture Kimball Crane Serv Inc KMI Construction Koepl Inc Fritz Kohler Pit Inc Kolo Trucking & Exc Koski Company J Kraemer & Sons Edward Kraemer Const Inc Kraemer Mining & Material KS Energy Services Inc Kuehne Company Inc La Crosse Backhoe Inc LafargeNA Inc Lakehead Const Inc Landwehr Constr Larson Const Co Inc Layne-Western Co Inc Leis Exc Inc Steve Lewis Constr Inc Linck Aggregates Inc Lonsdale Constr Inc LS Marine Inc Luedtke Engr Co Lunda Const Co MJ Construction Inc MZ Construction Inc Madison Crush Exca C Magill Const Co Mainline S & W Inc Malcolm Drilling Co Inc Mammoet USA North Inc Mandt Trkg & Exc Inc Mann Bros Inc Marine Tech Marinette County Marley Cool Twr Co Marohl Inc Henry R Martell Const Inc Mashuda Contractor Mathy Const Co Mattison Contractors Mc Dowell Affordable Concrete McCabe Constr Inc McDowell Const Corp McGough Constr McGuire Inc McHugh Excavating McMullen & Pitz Cons Mercer Sanitary Distr #1 Meridian Ind Srv Corp Merrill Gravel & Con Merryman Excavating Meyer & Sons CR Meyer Contracting Inc Meyer Material Co Michels Foundations Inc Michels Materials (Div of Michels PLine) Michels Pipeline Co Midstate Companies Midwest Asphalt Corp Midwest Const Co Inc Midwest Drilled FoundEng Inc Midwest Stairs & Iron Midwest Underground Milestone Material MilestoneCroft Division Miller's Blasting Sv Minnesota Limit Inc Miron Construction MJ Vandamme Inc Modern Crane Srv Inc Moll Construction Inc Monarch Paving Co Monona Plbg & Fire Moorhead Mach Boiler Moretrench Amer Corp Mortenson Co MA Mt Carmel Stabilization Grp MTec Environmental Munson Inc Musson Bros Inc Naes Power Contr New Berlin Grad Inc Nicholson Construction Co North Shore Track Constr Northeast Asphalt Inc Northern Clearing In Northern Dewater Inc Northern Interstate Northern State Power Northland Constructors-Duluth Northwest Asphalt Northwoods Paving Oakes & Son Inc AW Oliver Const Co Olson Bros Omega Demo Corp Ostrenga Excavating Oudenhoven Co Inc Oz Directional Drilling Parisi Const Co Paschke Const Co Inc Pavement Maint Inc Payne & Dolan Inc Penhall Co Pertzborn Corp HJ Peters Heavy Constr Peterson & Son Utility Div Peterson Company Inc Peterson Son Inc J Petroleum Equipment Inc Pheifer Brothers Constr Co Inc Platt Construction Plennes Inc Pohl Inc J & A Portable Barge Serv Inc Portzen Const Inc Potratz Conc Pmpg So Potratz Conc Pumping Inc Praeger & Sons Don Precision Grdg Util Preload Co Inc Pro Electric Inc Prof Manpower Svs Inc Proffesional Lanscape Contr Prostko Grading Pullman Power Prod Pumpkin Inc Purpero Inc CW Q3 Contracting Inc R & R Wash Materials R Cleveland UG Technologies R & J Underground Inc Radandt Sons Inc Fred Raemisch & Sons FH Rajon Const Inc Rausch Construction Rawson Contractors Relyco Inc Reynolds Rigging & Crane Reynolds Transfer & Storage Ricci Welch Inc Rice & Sons Ivan River-View Constr Rock Rd Co's Rohde Inc Doug Ruzic Construction Co Inc Ryan Inc Central S & L Underground & Trkg Inc SX Blasting Safety Grooving & Grinding Sanchez Group Sanford Construction Inc Schlobohm Exc Inc Schmidt Inc CG Schmitt Inc RG Schneider Exc Inc Schultz Constr JW Sevenson Env Servs Shared Systems Technology Siemens Generation Services Co Silha & Sons Exc Simon Landscaping Co Inc Sirrah Construction Smith & Son Charles Sommers Const Inc South Central Contr'g Inc Sowles Co Spancrete Inc-Valder SPE Inc Speedway Sand & Gravel Sperry Trkg Inc St Joseph Contract Stack Bros Mechanical Standard Sidewalk State Contractors Inc Stone Creek Contractors Straightline Grdg & Exc Stretar Masonry Inc Strupp Trucking Inc Stuczynski Trk & Exc Subsurface Constructors Sunny Slope Grading Super Excavators Super Western Inc SX Foundations T & T Tree Service T J S Maintenance Taylor Ridge Drilled Fdns Terra Eng & Const Co Tetra Tech EC Inc Thieding Const Inc Tiller Corporation TJ's Trucking & Exc Tomah Environmental Contrs Inc Tomasini Inc DF Tri City Concrete Contr Tri-County Paving Inc Trico Excavating Inc Trierweiler Const Su Tyler Company Inc Udeen Trucking Inc Underground PL Inc United Piping Inc United Sewer & Water USA Hoist Utility Services Authority Valley Rich Co Inc Van Straten Const Co Inc Veit & Company Inc Veolia EsMallard Ridge Viner Inc Harry Vinton Const Co Vonasek & Schieffer Vulcan Materials (Dousman) Vulcan Materials (Mil) Vulcan Materials (Racine) WK Construction Co Wagner Excavating Inc Walsh Constr Co The Wanasek Company Washington Group Int'l Waste Mngmt of WI Inc Waubonsee Developers Waukesha Lime & Stone Wells Concrete Prod West Bend Sand & Stone Inc West-land Restoration Inc White Construction Will Powers Svs Inc Willkomm Exc & Grd Inc Windlake Grdg Lndscpg Wingra Stone Company Winter & Sons Inc Wissota Sand Grav EC Witherup Constr Witherup Fabrication Yahara Materials Inc Zenith Tech Inc Zenke Inc Town of Bennett Town of Conover Town of Fifield Town of Kimball Town of Maple Town of Oakland Town of Russell Village of Solon Springs Town of Saxon Town of Spider Lake Town of Wausau Village of Webster Town of Winter 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0