2013-02-14T16:29:22-06:00 2012-04-30 BENDA GRACE STULZ & COMPANY PC 38800 VAN DYKE AVE STE 100 STERLING HEIGHTS MI 48312 990 2011-05-01 382988356 TILE MARBLE & TERRAZZO INSURANCE FUND TILE 2488139800 700 TOWER DRIVE SUITE 300 ROOM/SUITE 300 TROY MI 48098 ROBERT MICHIELUTTIMARK KING 2488139800 2012-08-28 BRYAN STULZ 5868836240 2013-02-14 2011 2016-03-07 17:11:31Z SAME AS ABOVE 3533820 false X X PROVIDE HEALTH AND WELFARE BENEFITS. 8 4 0 0 0 2522319 2755104 89100 127283 218131 132890 2829550 3015277 0 2445535 2649493 0 0 0 355647 336746 2801182 2986239 28368 29038 3245627 3209373 482641 438039 2762986 2771334 PROVIDE HEALTH AND WELFARE BENEFITS. false false 2649493 TO PROVIDE HOSPITALIZATION, MEDICAL AND OTHER HEALTH CARE BENEFITS TO ELIGIBLE PLAN PARTICIPANTS. 2649493 false false false false false false false false false false false false false true false true false false false false false false false false false false false false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false X 8 4 true false false false false true false true true false false false true true true false true false false false X BENESYS INC 2488139800 700 TOWER DRIVE SUITE 300 TROY MI 48098 X MARK KING 1.00 X 0 101034 0 CHUCK KUKAWAKA 1.00 X 0 93727 0 PETE ACCICA 1.00 X 0 72036 13654 TIM OCHALEK 1.00 X 0 72035 13654 ROBERT MICHIELUTTI 1.00 X 0 0 0 CLAY HAWTHORNE X 0 0 0 RON CAPP X 0 0 0 MICHAEL MAIURI X 0 0 0 JACK DIGIOVANNI X 0 0 0 338832 27308 false false false BENESYS INC 700 TOWER DRIVE SUITE 300 TROY MI 48098 ADMINISTRATOR 129456 NOVARA TESIGA PLLC 2000 TOWN CENTER SUITE 2370 SOUTHFIELD MI 480751314 LEGAL 105361 2 EMPLOYER CONTRIBUTIONS 230000 1883263 1883263 EMPLOYEE CONTRIBUTIONS 230000 871841 871841 2755104 88413 88413 557413 518543 38870 38870 38870 MEDICARE PART D SUBSIDY 900099 119587 119587 COBRA SUBSIDY 900099 13197 13197 LIQUIDARED DAMAGES 900099 106 106 132890 3015277 2926864 88413 2649493 2649493 105361 105361 30759 30759 8448 8448 140061 140061 32259 32259 7862 7862 6166 6166 HIPAA COMPLIANCE 5830 5830 2986239 2649493 336746 0 367417 593879 267061 451404 12049 16730 2599100 2147360 3245627 3209373 52641 47039 430000 391000 482641 438039 X 2762986 2771334 2762986 2771334 3245627 3209373 29038 -20690 X false false false false false false false false false false false false ACCUMULATED E;IGIBILITY CREDITS 200000 CLAIMS INCURRED BUT NOT REPORTED 191000 391000 3015277 2986239 29038 -20690 -20690 8348 2986139 -20690 -20690 3006829 8448 8448 3015277 2977791 2977791 8448 8448 2986239 ADDITIONAL INFORMATION FORM 990, PART VI LINE 2 - FAMILY RELATIONSHIP OR BUSINESS RELATIONSHIP - THE RELATIONSHIP BETWEEN THE TRUSTEES OF THE FUND IS A 'BUSINESS RELATIONSHIP'. THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDE. THE FUND, AS A TAFT-HARTLEY FUND, IS ADMINISTERED BY A BOARD OF TRUSTEES WHICH IS COMPOSED OF AN EQUAL NUMBER OF UNION AND EMPLOYER REPRESENTATIVES. BECAUSE OF THIS ORGANIZTIONAL REQUIREMENT, THERE IS A BUSINESS RELATIONSHIP BETWEEN THE TRUSTEES. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A ALL BOARD MEMBERS ARE ELECTED BY THE MEMBERSHIP INTO OFFICER POSITIONS, FROM WHICH THEY HOLD THEIR TRUSTEESHP EX OFFICIO. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PRESENTED AND APPROVED AT MEETING OF THE BOARD OF TRUSTEES, SUBJECT TO APPROVAL AND REVIEW BY THE FUND LEGAL COUNSEL. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C THE TRUSTEE SHARL PROVIDE HIS OR HER FULL COOPERTION TO THE BOARD, IN ORDER TO ENSURE THAT THE BOARD HAS A COMPLETE UNDERSTANDING OF THE CONFLICT AND ITS EFFECT ON THE FUND OPERATIONS. HE OR SHE SHALL ANSWER ANY QUESTIONS POSED BY THE BOARD TO THE BEST OF HIS OR HER ABILITY, AND SHALL SUPPLY THE BOARD WITH ANY RELEVANT DOCUMENATATION RELATED TO THE CONFLICT, UPON REQUEST. FUTHERMORE, A TRUSTEE WITH A CONFLICT OF INTEREST SHALL NOT VOTE ON MATTERS WHERE THE CONFLICT IS APPLICABLE. SUCH TRUSTEE ALSO SHALL NOT PARTICIPATE IN DUSCUSSIONS AS AN ADVOCATE ON MATTERS AFFECTING HIS OR HER PERSONAL INTERESTS AT MEETINGS OR THROUGH PRIVATE CONTACTS WITH THE CONFLICTING PARTY, BUT MAY RESPOND TO REQUETS FOR FACTUAL INFORMATION FROM OTHER TRUSTEES NEEDED TO REACH AN INFORMED DECISION. IN ADDITION, IN SOME SITUATIONS, A TRUSTEE WHO IS DETERMINED TO HAVE A CONFLICT OF INTERST MAY BE REQUESTED BY THE BOARD TO NOT BE PRESENT DURING THE REVIEW OF SUCH MATTERS, TO AVOID INHIBITING FREE DISCUSSION BY THE BOARD. THE DUTY TO DISCLOSE CONFLICTS OF INTEREST IS AN ONGOING ONE. ANY MATERIAL CHANGES IN STATUS OR INFORMATION REGARDING THE CONFLICT SHALL BE DISCLOSED TO THE BOARD EITHER VERBALLY OR IN WRITING, DURING ANY REGULARLY SCHEDULED TRUSTEES' MEETINGS. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT SECURITY ACT OF 1974, AS AMENDED. IT OPERATES IN COMPLIANCE WITH THE REPORTING AND DISCLOSURE REQUIREMENTS OF SUBTITLE B, PART 1 ERISA WITH RESPECT TO DISCLOSURE OF ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMAITON. IT OPERATES IN COMPLIANCE WITH THE FIDUCIARY RESPONSIBILITY REQUIREMENTS OF SUBTITLE B, PART 4 OF ERISA. ADDITIONAL INFORMATION FORM 990, PART VII LINE 1A - THE TURSTEES OF THE FUND SERVE WITHOUT COMPENSATION FROM THE FUND BUT ARE COMPENSATED AS EMPLOYEES OF THE ENTITIES THAT MIGHT BE A "SPONSORING ORGANIZATION OF A VEBA" OR "CONTRIBUTING EMPLOYER OF A VEBA"; HOWEVER, NONE OF THOSE ENTITIES CONTRIBUTED 10% OR MORE OF THE CONTRIBUTIONS TO THE FUND DURING THE TAX YEAR. (SEE THE INSTRUCTION TO SCHEDULE R.) SEE PART VII N/A false SEE PART VII N/A false false SEE PART VII N/A false false false false false false false false false false false false false false false false false false SEE PART VII false false false ADDITIONAL INFORMATION SCHEDULE R SCHEDULE R PARTS III IV AND V IDENTIFICATION OF RELATED ORGANIZATIONS THE FILING ORGANIZATION IS A MULTIEMPLOYER TRUST FUND AS DEFINED IN THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 AS AMENDED THE FUND PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS AS OF APRIL 30 2012 THERE WERE 30 CONTRIBUTING EMPLOYERS TO THE FUND UNDER THE INSTRUCTIONS TO SCHEDULE R THOSE EMPLOYERS ARE CONSIDERED RELATED ORGANIZATIONS THE FUNDS ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF ALL CONTRIBUTING EMPLOYERS INCLUDING NAMES ADDRESSES AND OTHER CONTACT INFORMATION HOWEVER THE FUND DOES NOT HAVE AND HAS NO REASONABLE WAY TO OBTAIN MUCH OF THE INFORMAITON TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND THE EMPLOYERS LEGAL STRUCTUREEG CORPORATION OR PARTNERSHIP THE FOLLOWING IS A LISTING OF THOSE CONTRIBUTING EMPLOYERS WHICH IS THE EXTENT OF THE INFORMATION THE FUND HAS WITH RESPECT TO EACH EMPLOYER CONTRIBUTING EMPLOYERS ARTISAN TILE INC BB TILE MARBLE CO INC BAC LOCAL NO 1 OF MI BOOMS STONE COMPANY BOSTON TILE TERRAZZO CO CSTONE INSTALLATION INC CALIDAD LLC CARLO TILE MARBLE CO COHN COMM FLOOR COVERING INC CONTRACT DESIGN GROUP ELDORADO TILE MARBLE COMPANY EMPIRE TILE COMPANY F D BERARDINO TILE INC FABRIS PEARCE TILE FIGLIOLI TILE STONE LLC HARD ROCK INVESTMENTS LLC INTERNATIONAL CERAMIC CONSTRUCTION L MARSON TILE MARBLE CO MARSON ENTERPRISES INC MICHIELUTTI BROS INC MICHIGAN TILE MARBLE CO MUSANTE TILE INC NATIONAL TILE CO SHAMROCK FLOOR COVERING SERVICE SHOCK BROS FLOOR COVER SHORES TILE CO INC STATE TILE CO INC TRISTATE ONDUSTRIAL FLOORS WOLVERINE STONE CO