TILE MARBLE & TERRAZZO INSURANCE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: TILE MARBLE & TERRAZZO INSURANCE (EIN 38-2988356)
Tax period: 2012-05-01 to 2013-04-30
Filed: 2013-12-16
IRS object ID: 201333509349300518
Schema version: 2012v2.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule D
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-12-16T10:23:34-06:00	Timestamp
Tax Period End Date	2013-04-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BENDA GRACE STULZ & COMPANY PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	38800 VAN DYKE AVE STE 100	AddressLine1
City	STERLING HEIGHTS	City
State	MI	State
ZIP Code	48312	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-05-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	382988356	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	TILE MARBLE & TERRAZZO INSURANCE	BusinessNameLine1
Business Name Line2	FUND	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	TILE	NameControl
Phone	2488139800	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	700 TOWER DRIVE SUITE 300	AddressLine1
Address Line2	ROOM/SUITE 300	AddressLine2
City	TROY	City
State	MI	State
ZIP Code	48098	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	ROBERT MICHIELUTTICHUCK KUKAWAKA	Name
Title	CHAIRMAN/SECRETARY	Title
Phone	2488139800	Phone
Date Signed	2013-11-20	DateSigned
Authorize Third Party	false	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	BRYAN STULZ	Name
Phone	5868836240	Phone
Date Prepared	2013-12-16	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	SAME AS ABOVE	NameOfPrincipalOfficerPerson
Gross Receipts	3320413	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c	X	Organization501c
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Activity Or Mission Description	PROVIDE HEALTH AND WELFARE BENEFITS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	8	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	4	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	2755104	ProgramServiceRevenuePriorYear
Program Service Revenue CY	2865715	ProgramServiceRevenueCY
Investment Income Prior Year	127283	InvestmentIncomePriorYear
Investment Income Current Year	27145	InvestmentIncomeCurrentYear
Other Revenue Prior Year	132890	OtherRevenuePriorYear
Other Revenue Current Year	112415	OtherRevenueCurrentYear
Total Revenue Prior Year	3015277	TotalRevenuePriorYear
Total Revenue Current Year	3005275	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	2649493	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	2666324	BenefitsPaidToMembersCY
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	336746	OtherExpensePriorYear
Other Expenses Current Year	360620	OtherExpensesCurrentYear
Total Expenses Prior Year	2986239	TotalExpensesPriorYear
Total Expenses Current Year	3026944	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	29038	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-21669	RevenuesLessExpensesCY
Total Assets BOY	3209373	TotalAssetsBOY
Total Assets EOY	3361904	TotalAssetsEOY
Total Liabilities BOY	438039	TotalLiabilitiesBOY
Total Liabilities EOY	564179	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	2771334	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	2797725	NetAssetsOrFundBalancesEOY
Mission Description	PROVIDE HEALTH AND WELFARE BENEFITS.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	2666324	Expense
Description	TO PROVIDE HOSPITALIZATION, MEDICAL AND OTHER HEALTH CARE BENEFITS TO ELIGIBLE PLAN PARTICIPANTS.	Description
Total Program Service Expense	2666324	TotalProgramServiceExpense
Described In501 C3	false	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	false	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	0	NumberOfEmployees
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	8	NbrVotingGoverningBodyMembers
Number Independent Voting Members	4	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	BENESYS INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	2488139800	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	700 TOWER DRIVE SUITE 300	AddressLine1
City	TROY	City
State	MI	State
ZIP Code	48098	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
MARK KING
SECRETARY	1.00	40.00	X	0	104434	0
CHUCK KUKAWAKA
TRUSTEE	1.00	40.00	X	0	97115	0
TIM OCHALEK
TRUSTEE	1.00	40.00	X	0	76695	14144
PETE ACCICA
TRUSTEE	1.00	40.00	X	0	76694	14144
ROBERT MICHIELUTTI
CHAIRMAN	1.00		X	0	0	0
RON CAPP
TRUSTEE	1.00		X	0	0	0
MICHAEL MAIURI
TRUSTEE	1.00		X	0	0	0
JACK DIGIOVANNI
TRUSTEE	1.00		X	0	0	0

Field	Value	IRS element (for citing)
Total Reportable Comp Frm Rltd Orgs	354938	TotalReportableCompFrmRltdOrgs
Total Other Compensation	28288	TotalOtherCompensation
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
NOVARA TESIGA PLLC
2000 TOWN CENTER SUITE 2370	SOUTHFIELD	MI	480751314	LEGAL	196160
BENESYS INC
700 TOWER DRIVE SUITE 300	TROY	MI	48098	ADMINISTRATOR	189471

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	2	NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS	2035035	2035035
EMPLOYEE CONTRIBUTIONS	830680	830680

Field	Value	IRS element (for citing)
Total Program Service Revenue	2865715	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	70285	TotalRevenueColumn
Exclusion	$70,285	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	271998	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	315138	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	-43140	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-43140	TotalRevenueColumn
Related Or Exempt Function Income	-43140	RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	MEDICARE PART D SUBSIDY	Description
Business Code	900099	BusinessCode
Total Revenue Column	112415	TotalRevenueColumn
Related Or Exempt Function Income	112415	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	112415	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	3005275	TotalRevenueColumn
Related Or Exempt Function Income	2934990	RelatedOrExemptFunctionIncome
Exclusion	$70,285	ExclusionAmount

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	2666324	Total
Program Services	2666324	ProgramServices

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	138716	Total
Management And General	138716	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	24522	Total
Management And General	24522	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	7905	Total
Management And General	7905	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	141782	Total
Management And General	141782	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	30051	Total
Management And General	30051	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	8280	Total
Management And General	8280	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	5531	Total
Management And General	5531	ManagementAndGeneral

Other Expenses OtherExpenses

Field	Value	IRS element (for citing)
Description	HIPAA COMPLIANCE	Description
Total	3833	Total
Management And General	3833	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	3026944	Total
Program Services	2666324	ProgramServices
Management And General	360620	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	593879	BOY
EOY	698462	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	451404	BOY
EOY	432880	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	16730	BOY
EOY	13139	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	2147360	BOY
EOY	2217423	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	3209373	BOY
EOY	3361904	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	47039	BOY
EOY	58179	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	391000	BOY
EOY	506000	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	438039	BOY
EOY	564179	EOY

Field	Value	IRS element (for citing)
Do Not Follow SFAS117	X	DoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

Field	Value	IRS element (for citing)
BOY	2771334	BOY
EOY	2797725	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2771334	BOY
EOY	2797725	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3209373	BOY
EOY	3361904	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-21669	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	48060	ReconciliationUnrealizedInvest
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule D IRS990ScheduleD

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
CLAIMS INCURRED BUT NOT REPORTED	$315,000
ACCUMULATED E;IGIBILITY CREDITS	$191,000

Field	Value	IRS element (for citing)
Total Of Amounts	506000	TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt	3045430	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	48060	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	48060	RevenueNotRptdF990
Revenue Subtotal	2997370	RevenueSubtotal
Investment Expenses Not Included	7905	InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt	7905	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	3005275	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	3019039	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	3019039	ExpensesSubtotal
Investment Expenses Not Included2	7905	InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt	7905	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	3026944	TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
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.)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	SEE PART VII	BusinessNameLine1

Field	Value	IRS element (for citing)
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Controlled Org	false	ControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	SEE PART VII	BusinessNameLine1

Field	Value	IRS element (for citing)
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Disproportionate Allocations	false	DisproportionateAllocations
General Or Managing Partner	false	GeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	SEE PART VII	BusinessNameLine1

Field	Value	IRS element (for citing)
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Controlled Org	false	ControlledOrg

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	false	DividendsRelatedOrganization
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	false	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Identifier	ADDITIONAL INFORMATION	Identifier
Return Reference	SCHEDULE R	ReturnReference
Explanation	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 48 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 AMERICAN CONTRACT FLOORING CO ARCHITECTURAL SOUTHWEST STONE ARCHITECTURAL STONE PRODUCTS ARTISAN TILE INC BB TILE MARBLE CO INC BAC LOCAL NO 1 OF MI BOMMARITOS TILE BOOMS STONE COMPANY BOSTON TILE TERRAZZO CO CSTONE INSTALLATION INC CALIDAD LLC CARLO TILE MARBLE CO CITY CARPET FLOORING CLEVELAND MARBLE MOSIAC CMU MASONRY COHN COMM FLOOR COVERING INC COMMERICAL FLOORING OF TOLEDO CONTRACT DESIGN GROUP DETROIT PROPERTY IMPROVEMENT ELDORADO TILE MARBLE COMPANY EMPIRE TILE COMPANY F D BERARDINO TILE INC FABRIS PEARCE TILE FERRUCHIO BUILDING COMPANY FIGLIOLI TILE STONE LLC GALL CONSTRUCTION OF AMERICA GLENNS TILE CARPET GREAT LAKES STONE HARD ROCK INVESTMENTS LLC HOSPITALITY STONE LLC INTERNATIONAL CERAMIC CONSTRUCTION L M TILE CO INC L MARSON TILE MARBLE CO MARSON ENTERPRISES INC MICHIELUTTI BROS INC MICHIGAN TILE MARBLE CO MONTE COSTELLA INC MUSANTE TILE INC NATIONAL TILE CO PROGRESSIVE CONSTRUCTION SERVICES SHAMROCK FLOOR COVERING SERVICE SHOCK BROS FLOOR COVER SHORES TILE CO INC SOUTHEASTERN TILE LLC STATE TILE CO INC TERRA BELLA TERRAZZO MOSAIC INC TRENDELL CONSULTING LLC WOLVERINE STONE CO	Explanation