2013-03-13T15:28:34-05:00 2012-05-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2011-06-01 396095127 FOX VALLEY SHEET METAL HEALTH FUND FOXV 2627981838 2201 SPRINGDALE ROAD WAUKESHA WI 531862855 NICHOLAS LIESCH 2627981838 2013-03-05 1 JAMES M ASHLAND CPA P00241858 2627846210 2011 2016-03-07 17:11:31Z NICHOLAS LIESCH 2201 SPRINGDALE ROAD WAUKESHA WI 531862855 12776675 0 X N/A X 1981 WI TO PROVIDE WELFARE BENEFITS, SUCH AS LIFE INSURANCE, ACCIDENTAL DEATH AND DISMEMBERMENT, LOSS OF TIME, DISABILITY, DENTAL, VISION, HOSPITAL, AND SURGICAL BENEFITS FOR UNION MEMBERS AND THEIR SPOUSE AND/OR DEPENDENTS 6 6 0 0 0 0 0 0 7557310 8028119 331850 480369 0 85845 7889160 8594333 0 0 5984780 7094115 0 0 0 0 0 798920 1479023 6783700 8573138 1105460 21195 10946522 11414148 2770891 3041837 8175631 8372311 PROVIDE HEATH AND WELFARE BENEFITS FOR PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 8135885 TO PROVIDE HEALTH, LIFE, DENTAL, VISION, AND DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS, SPOUSES, AND DEPENDENTS. 8135885 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 236 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X SUZANNE TAZALLA 2627981838 2201 SPRINGDALE ROAD WAUKESHA WI 531862855 X CHARLES SCHUSTER 1.00 X X 0 0 0 NICHOLAS LIESCH 1.00 X X 0 0 0 PATRICK LANDGRAF 1.00 X 0 0 0 PAUL HANSEN 1.00 X 0 0 0 TOM FELDMANN 1.00 X 0 0 0 JEFFREY GAECKE 1.00 X 0 0 0 0 0 0 0 0 0 0 RELIASTAR LIFE INSURANCE COMPANY 20 WASHINGTON AVENUE SOUTH MINNEAPOLIS MN 55401 STOP LOSS, LIFE AND ACCIDENTAL DEATH & D 585400 UNITED HEALTH CARE INSURANCE COMPANY 10701 W RESEARCH DRIVE MILWAUKEE WI 53226 CLAIMS PROCESSING 206748 BENEFIT PLAN ADMINISTRATION 11270 WEST PARK PLACE SUITE 950 MILWAUKEE WI 53224 THIRD PARTY ADMINISTRATOR 175528 THE SEGAL COMPANY 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 606061724 CONSULTING 108196 4 EMPLOYER CONTRIBUTIONS 900099 6996163 6996163 STOP LOSS REIMBURSEMEN 900099 698008 698008 PARTICIPANT CONTRIBUTI 900099 315590 315590 PAYMENTS FROM OTHER LO 900099 18358 18358 8028119 299096 299096 4363615 4182342 181273 181273 181273 MEDICAL/SUBROGATION RE 900099 65409 65409 COBRA SUBSIDY REIMBURS 900099 17947 17947 OTHER REVENUE 900099 2489 2489 85845 8594333 8209392 0 384941 7094115 7094115 130217 130217 49038 49038 21375 21375 42211 42211 108196 108196 13201 13201 487 487 5869 5869 STOP LOSS PREMIUMS 572576 572576 PPO SERVICE ADMINISTRAT 206748 206748 HRA CLAIMS PAID 158362 158362 RECIPROCITY PAYMENTS TO 53135 53135 117608 50949 66659 8573138 8135885 437253 0 255942 2318030 260100 638474 67329 8503 7896140 10149581 665023 101548 10946522 11414148 80291 160737 2690600 2881100 2770891 3041837 X 8175631 8372311 8175631 8372311 10946522 11414148 X 21195 175485 X X 0 1 1 X 0 0 BENEFIT CLAIMS PAYABLE AND IBNR 546100 ESTIMATED LIABILITY FOR FUTURE BENEFITS 2335000 2881100 8594333 8573138 21195 175485 175485 196680 8674472 175485 175485 8498987 42211 53135 95346 8594333 8287292 0 8287292 42211 243635 285846 8573138 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF MAY 31, 2012, THERE ARE 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. THE PLAN MANAGEMENT BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO MAY 31, 2009. PART XII, LINE 4B - OTHER ADJUSTMENTS: PAYMENTS TO OTHER LOCALS 53,135. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN HEALTH CLAIMS PAYABLE 190,500. PAYMENT TO OTHER LOCALS 53,135. FORM 990, PART VI, SECTION B, LINE 11 REVIEWED BY THE ADMINISTRATIVE MANAGER AND PRESENTED TO TRUSTEES FOR APPROVAL PRIOR TO SIGNING AND FILING. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ARE EXPECTED TO DISCLOSE ANY OWNERSHIP OR OTHER FINANCIAL RELATIONSHIPS THAT THEY HAVE WITH PARTIES THAT DEAL WITH THE PLAN. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST THROUGH THE PLAN OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 175,485. PART XII, LINE 2C THE BOARD OF TRUSTEES REVIEWS AND APPROVES A DRAFT OF THE AUDITED FINANCIAL STATEMENTS AT THE MEETING. THESE ARE PRESENTED BY THE ACCOUNTANT TO THE BOARD.