2013-02-04T11:52:07-06:00 2012-05-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2011-06-01 510210922 NATIONAL ROOFERS UNION & EMPLOYERS JOINT HEALTH & WELFARE FUND NATI 3034264984 PO BOX 21240 DENVER CO 80221 JOHN PLESCIA 3034264984 2013-02-04 1 CRAIG RESCH P00844633 3123680500 2011 2016-02-25 16:41:14Z JOHN PLESCIA PO BOX 21240 DENVER CO 80221 8744449 0 X N/A X 1976 CO TO PROVIDE HEALTH BENEFITS 6 0 0 0 0 0 0 0 6343088 6539907 285165 447515 7025 4041 6635278 6991463 0 0 5624998 5514735 0 0 0 0 0 565921 477067 6190919 5991802 444359 999661 9615080 10152006 16489 40963 9598591 10111043 PROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 X 6 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X FRINGE BENEFIT SERVICES INC 3034264984 PO BOX 21240 DENVER CO 80221 KINSEY ROBINSON 1.00 X 0 294934 45129 JOHN PLESCIA 1.00 X 0 0 0 DENNIS CONWAY 1.00 X 0 0 0 MARK REEVES 1.00 X 0 0 0 PAUL BLASKI 1.00 X 0 148628 34771 DOUG ZIEGLER 1.00 X 0 52793 15610 0 496355 95510 0 0 1 0 CIGNA PO BOX 644546 PITTSBURGH PA 15264 MEDICAL PPO PROVIDER 225096 FRINGE BENEFIT SERVICES INC 7010 N BROADWAY SUITE 106 DENVER CO 80221 THIRD PARTY ADMINISTRATOR 213230 2 EMPLOYER CONTRIBUTIONS 900099 6465083 6465083 PARTICIPANT CONTRIB 900099 70371 70371 COBRA SUBSIDIES 900099 4453 4453 6539907 261686 261686 1938815 1752986 185829 185829 185829 MISCELLANEOUS REVENUE 900099 4041 4041 4041 6991463 6539907 0 451556 5514735 203603 117843 27152 21619 78434 8817 10713 5568 MISCELLANEOUS 3318 5991802 235572 131254 1013268 887452 643270 580762 3603 3091 7512655 8335071 206712 214376 9615080 10152006 16489 40963 16489 40963 X 0 0 0 0 9598591 10111043 9598591 10111043 9615080 10152006 X 999661 -487209 X 0 1 1 X 0 0 6991463 5991802 999661 -487209 -487209 512452 6482635 -487209 -487209 6969844 21619 21619 6991463 5970183 0 5970183 21619 21619 5991802 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM TAX, AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. 0 0 0 KINSEY ROBINSON 0 189754 0 0 0 105180 0 19924 0 25205 0 340063 0 0 PAUL BLASKI 0 132828 0 0 0 15800 0 10204 0 24567 0 183399 0 0 FORM 990, PART VI, SECTION A, LINE 3 WHILE THE BOARD OF TRUSTEES RETAINS THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO FRINGE BENEFITS SERVICES, INC. AS THIRD PARTY ADMINISTRATOR OF THE FUND. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO AND REVIEWED BY THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C FUND PERSONNEL HAVE THE CONTINUING RESPONSIBILITY TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. IN ANY DETERMINATION BY THE TRUSTEES OF A CONFLICT OF INTEREST, THE PERSON WITH THE CONFLICT OF INTEREST SHALL BE EXCLUDED FROM THE DISCUSSION AND DETERMINATION OF SUCH CONFLICT. DISCLOSURE OF A CONFLICT OF INTEREST SHOULD BE MADE TO THE ADMINISTRATIVE MANAGER, WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF. DISCLOSURE INVOLVING TRUSTEES SHOULD BE MADE TO THE CHAIRMAN OF THE BOARD OF TRUSTEES, WHO SHALL BRING THESE MATTERS TO THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF. THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF SHALL DETERMINE WHETHER A CONFLICT EXISTS AND, IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR AND REASONABLE TO THE FUND. THE DECISION OF THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION, AND THEIR CONCERN SHALL BE THE WELFARE OF THE PLAN AND THE ADVANCEMENT OF ITS PURPOSE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -487,209. FORM 990, PART VI, SECTION A, LINE 1B ALL OF THE PLAN'S TRUSTEES ARE COMPENSATED BY AN EMPLOYER WHO CONTRIBUTES TO THE FUND, WHICH IN ACCORDANCE WITH THE INSTRUCTIONS, MAKES THEM A RELATED ORGANIZATION. CONSEQUENTLY, NONE OF THE TRUSTEES ARE CONSIDERED INDEPENDENT FOR REPORTING ON THIS LINE ITEM. AZ ROOFERS LOCAL #135 1917 E WASHINGTON PHOENIX AZ 85034 CONTRIBUTING EMPLOYER AZ 501(C)5 N/A N/A 0 NV ROOFERS JATC 4125 ARCTIC SPRING AVESTE 4 LAS VEGAS NV 89115 CONTRIBUTING EMPLOYER NV 501(C)5 N/A N/A 0 NV ROOFERS LOCAL #162#5 4125 ARCTIC SPRINGS AVE LAS VEGAS NV 89115 CONTRIBUTING EMPLOYER NV 501(C)5 N/A N/A 0 OK ROOFERS JATC 111 NE 26TH ST OKLAHOMA CITY OK 73105 CONTRIBUTING EMPLOYER OK 501(C)3 N/A N/A 0 ROOFERS LOCAL UNION #143 111 NE 26TH STREET OKLAHOMA CITY OK 73105 CONTRIBUTING EMPLOYER OK 501(C)5 N/A N/A 0 ROOFERS LOCAL UNION #182 750 49TH ST MARION IA 52302 CONTRIBUTING EMPLOYER IA 501(C)5 N/A N/A 0 ROOFERS LOCAL UNION #20 6321 BLUE RIDGE BLVD STE 202 RAYTOWN MO 64133 CONTRIBUTING EMPLOYER MO 501(C)5 N/A N/A 0 ROOFERS LOCAL UNION #317 3260 WINBOURNE AVENUE BATON ROUGE LA 70805 CONTRIBUTING EMPLOYER LA 501(C)5 N/A N/A 0 ROOFERS LOCAL UNION #6 1003 BELVEDERE RD WEST PALM BEACH FL 33405 CONTRIBUTING EMPLOYER FL 501(C)5 N/A N/A 0 ROOFERS LOCAL UNION #91 2261 SO REDWOOD RD SUITE N SALT LAKE CITY UT 84119 CONTRIBUTING EMPLOYER UT 501(C)5 N/A N/A 0 UNITED UNION OF ROOFERS ET AL 1660 L STREET NW STE 800 WASHINGTON DC 20036 CONTRIBUTING EMPLOYER DC 501(C)5 N/A N/A 0 A HERRMANN ASSOCIATES 2351 THOMAS STREET HOLLYWOOD FL 33020 CONTRIBUTING EMPLOYER FL C A W FARRELL & SON INC 3761 E LAKE ROAD DUNKIRK NY 14048 CONTRIBUTING EMPLOYER NY C ANTHONY ROOFING 2555 WHITE OAK CIRCLE AURORA IL 60502 CONTRIBUTING EMPLOYER IL C APPLIED TECHNOLOGY DIVISION P O BOX 921001 FORT WORTH TX 76121 CONTRIBUTING EMPLOYER TX C ARIZONA ROOF CONSULTANT LLC 1753 E BROADWAY RD 101-291 TEMPE AZ 85282 CONTRIBUTING EMPLOYER AZ C ASCENSION ROOFING P O BOX 192 GONZALES LA 70707 CONTRIBUTING EMPLOYER LA C BENNETT & BROSSEAU ROOFING INC 535 ANDERSON DR ROMEOVILLE IL 60446 CONTRIBUTING EMPLOYER IL C BI-STATE ROOF SYSTEMS 600 GLOVER VALLEY PARK MO 63088 CONTRIBUTING EMPLOYER MO C CENTRAL STATES ROOFING 5925 OMAHA BLVD COLORADO SPRINGS CO 80915 CONTRIBUTING EMPLOYER CO C COMMERCIAL ROOFERS 3865 WEST NAPLES DRIVE LAS VEGAS NV 89103 CONTRIBUTING EMPLOYER NV C CONTRACTORS WATERPROOFING LLC P O BOX 176 103 W 2ND AVE CHENEY KS 67025 CONTRIBUTING EMPLOYER KS C CRIBBS INC P O BOX 64854 BATON ROUGE LA 70898 CONTRIBUTING EMPLOYER LA C CUMBERLAND ROOFING LLC 13343 W WATSON LANE SURPRISE AZ 85379 CONTRIBUTING EMPLOYER AZ C DEAN ROOFING 5525 CAMERON RD LAS VEGAS NV 89118 CONTRIBUTING EMPLOYER NV C DFW PRO ROOFING LLC 1100 CAROLINE DR PRINCETON TX 75405 CONTRIBUTING EMPLOYER TX C DRYSPACE INC 707 66TH AVE SW CEDAR RAPIDS IA 52404 CONTRIBUTING EMPLOYER IA C EAGLE ROOFING 3161 E 45TH ST TUCSON AZ 85713 CONTRIBUTING EMPLOYER AZ C EBERHARD SOUTHWEST 3995 W DEWEY DR LAS VEGAS NV 89118 CONTRIBUTING EMPLOYER NV C ENTERPRISE ROOFING SERVICE INC PO BOX 5130 CONCORD CA 94524 CONTRIBUTING EMPLOYER CA C GENERAL CAULKING & COATING CO INC 101 NW 176TH ST MIAMI FL 33169 CONTRIBUTING EMPLOYER FL C HAMMOND CAULKING CO 6575 S ARVILLE ST B LAS VEGAS NV 89118 CONTRIBUTING EMPLOYER NV C KIRBERG ROOFING 1400 S 3RD STREET ST LOUIS MO 63104 CONTRIBUTING EMPLOYER MO C LOS ALAMOS NATIONAL SECURITY LLC P O BOX 1663 MS P238 LOS ALAMOS NM 87545 CONTRIBUTING EMPLOYER NM C MARTON ROOFING INDUSTRIES LTD 5207 ASHBROOK HOUSTON TX 77081 CONTRIBUTING EMPLOYER TX C NOORDA SHEET METAL CO 4250 PRODUCTION CT LAS VEGAS NV 89115 CONTRIBUTING EMPLOYER NV C PELLERIN & WALLACE P O BOX 3172 LAFAYETTE LA 70502 CONTRIBUTING EMPLOYER LA C QUALITY EXTERIOR SERVICES LLC 234 AZORES DR SLIDELL LA 70458 CONTRIBUTING EMPLOYER LA C ROTH BROS INC 3847 CRUM RD YOUNGSTONW OH 44575 CONTRIBUTING EMPLOYER OH C ROYAL ROOFING 2445 BROWN RD ORION MI 48359 CONTRIBUTING EMPLOYER MI C RSS ROOFING SERVICES & SOLUTIONS 1054 CENTRAL INDUSTRIAL ST LOUIS MO 63110 CONTRIBUTING EMPLOYER MO C SALOMON ROOFING 689 WEST 26TH ST HIALEAH FL 33010 CONTRIBUTING EMPLOYER FL C SELLERS & MARQUIS LLC 3104 S GOLDEN AVE SPRINGFIELD MO 65807 CONTRIBUTING EMPLOYER MO C SHAY ROOFING INC 400 SOUTH BREESE STREET MILLSTADT IL 62260 CONTRIBUTING EMPLOYER IL C SILVER STATE WATERPROOFING LLC P O BOX 740940 LAS VEGAS NV 89136 CONTRIBUTING EMPLOYER NV C SOUTHWESTERN ROOFING & SHEETMETAL PO BOX 54858 OKLAHOMA CITY OK 73154 CONTRIBUTING EMPLOYER OK C STANDARD ROOFING & SHEET METAL PO BOX 60150 OKLAHOMA CITY OK 73146 CONTRIBUTING EMPLOYER OK C STAR ROOFING 9201 N NINTH AVENUE PHOENIX AZ 85021 CONTRIBUTING EMPLOYER AZ C SUPERIOR ROOFING 3405 SO 500 WEST SALT LAKE CITY UT 84115 CONTRIBUTING EMPLOYER UT C T & K ROOFING COMPANYINC PO BOX 279 ELY IA 52227 CONTRIBUTING EMPLOYER IA C TECHNICOAT WATERPROOFING 6879 SPEEDWAY BLVD STE V109 LAS VEGAS NV 89115 CONTRIBUTING EMPLOYER NV C THE ELLIS COMPANY INC P O BOX 1009 KENNER LA 70063 CONTRIBUTING EMPLOYER LA C THE FRED CHRISTEN & SONS CO PO BOX 547 TOLEDO OH 43697 CONTRIBUTING EMPLOYER OH C TRIPLE M ROOFING COMPANY 914 NW 19TH AVE FT LAUDERDALE FL 33311 CONTRIBUTING EMPLOYER FL C US INDUSTRIES GROUP 1701 1ST AVE EVANSVILLE IN 47710 CONTRIBUTING EMPLOYER IN C UTAH TILE & ROOFING INC 555 WEST 3900 SOUTH BLDG C SALT LAKE CITY UT 84123 CONTRIBUTING EMPLOYER UT C VAUGHAN ROOFING 4911 I-10 FRONTAGE RD PORT ALLEN LA 70767 CONTRIBUTING EMPLOYER LA C WILLIAMS SPECIALTY SVCS LLC 100 CRESCENT CNTR PKWY1240 TUCKER GA 30084 CONTRIBUTING EMPLOYER GA C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FORM 990, SCHEDULE R, PART IV THE INFORMATION IN PART IV REGARDING THE FUND'S CONTRIBUTING EMPLOYERS IS THE INFORMATION THAT WAS READILY AVAILABLE TO THE FUND. THE EMPLOYER IDENTIFICATION NUMBERS OF THE CONTRIBUTING EMPLOYERS REPORTED HAVE NOT BEEN INCLUDED IN THIS FILING DUE TO THE SENSITIVE NATURE OF THE INFORMATION. THE INFORMATION MAY BE AVAILABLE AT THE FUND OFFICE.