2012-10-30T14:14:35-05:00 2011-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2011-01-01 351638874 WISCONSIN SHEET METAL WORKERS HEALTH AND BENEFIT FUND WISC 4147780516 2201 SPRINGDALE ROAD WAUKESHA WI 531862855 PATRICK LANDGRAF 2627981818 2012-10-30 1 JAMES M ASHLAND CPA P00241858 2627846210 2011 2016-02-24 21:20:13Z PATRICK LANDGRAF 2201 SPRINGDALE ROAD WAUKESHA WI 531862855 65992774 0 X N/A X 1985 WI TO PROVIDE HEALTH AND WELFARE BENEFITS FOR PARTICIPANTS AND THEIR BENEFICIARIES. 16 16 116 0 0 0 0 0 26415788 25255984 2523237 1895705 34257 110818 28973282 27262507 0 0 25421696 25666269 43052 50100 0 0 0 3808346 3844071 29273094 29560440 -299812 -2297933 47119329 43150316 16573158 14885668 30546171 28264648 X PROVIDE HEALTH AND WELFARE BENEFITS FOR PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 25666269 HOSPITAL, SURGICAL, MEDICAL, DENTAL, VISION, AND PRESCRIPTION DRUG BENEFITS FOR APPROXIMATELY 2,624 MEMBERS AND THEIR FAMILIES 1098605 PROVIDE SUPPLEMENTAL MEDICARE WRAPAROUND INSURANCE BENEFITS FOR APPROXIMATELY 800 MEMBERS 258510 PROVIDE MEDICAL CASE MANAGEMENT AND COST MANAGEMENT FOR APPROXIMATELY 2,100 MEMBERS 94722 LIFE INSURANCE PREMIUMS $94,722 94722 27118106 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 292 0 116 1 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X SUZANNE TAZALLA 2627981838 2201 SPRINGDALE ROAD WAUKESHA WI 531862855 X TODD BLAIR 1.00 X 0 0 0 ROGER JACKSON 1.00 X 0 0 0 MIKE MOONEY 1.00 X 0 0 0 KEITH KEMPER 1.00 X 0 0 0 RANDALL KROCKA 1.00 X X 0 0 0 BRIAN BILLMAN 1.00 X 0 0 0 STEVEN HARVALA 1.00 X 0 0 0 PATRICK LANDGRAF 1.00 X X 0 0 0 DAVID ALDAG 1.00 X 0 0 0 KENNETH GROESCHEL 1.00 X 0 0 0 ROBERT JOSSART 1.00 X 0 0 0 TIM BRAUN 1.00 X 0 0 0 RICHARD NORTHRUP 1.00 X 0 0 0 KENDALL RICHARDS 1.00 X 0 0 0 JEFFREY GAECKE 1.00 X 0 0 0 LAURI ROLLINGS 1.00 X 0 0 0 0 0 0 0 0 0 0 BENEFIT PLAN ADMINISTRATORS 11270 W PARK PLACE SUITE 950 MILWAUKEE WI 53224 RECORDKEEPING AND PAYROLL AUDIT SERVICES 885072 UNITED HEALTHCARE 22703 NETWORK PLACE CHICAGO IL 606731227 MEDICAL CLAIMS ADMINISTRATION 484623 ANTHEM BLUE CROSS AND BLUE SHIELD 220 VIRGINIA AVENUE INDIANAPOLIS IN 46204 MEDICAL CLAIMS ADMINISTRATION 248710 THE SEGAL COMPANY 101 N WACKER DRIVE SUITE 500 CHICAGO IL 606061724 ACTUARIAL SERVICES 206331 CARE ALLIES 525 WEST MONROE CHICAGO IL 60661 COST CONTAINMENT SERVICES 151734 5 EMPLOYER CONTRIBUTIONS 900099 20671807 20671807 SELF-PAY CONTRIBUTIONS 900099 4318351 4318351 SASMI 900099 265826 265826 25255984 1311119 1311119 39314853 38730267 584586 584586 584586 SHARED EXPENSE REIMBUR 900099 83780 83780 CONTRACTOR LATE CHARGE 900099 27038 27038 110818 27262507 25951388 0 1311119 25666269 25666269 50100 50100 410499 410499 147003 147003 59926 59926 88620 88620 206331 206331 46219 46219 42110 42110 31121 31121 8330 8330 13148 13148 114704 94722 19982 CLAIMS ADMINISTRATOR FE 1256803 1256803 SMW PREMIUMS 1098605 1098605 COST CONTAINMENT PROGRA 258510 258510 BANK FEES 28914 28914 33228 33228 29560440 27118106 2442334 0 8971161 3788118 2017082 1874969 28080 23619 298854 280706 48484 18148 35750939 37094572 303583 350890 47119329 43150316 811724 469930 15761434 14415738 16573158 14885668 X 0 0 0 0 30546171 28264648 30546171 28264648 47119329 43150316 X -2297933 16410 X X 0 1 1 X 0 298854 280706 18148 18148 ESTIMATED HEALTH CLAIMS PAYABLE AND IBNR 2539500 ACCUMULATED BENEFITS - PARTICIPANTS 11757179 DUE TO OTHER FUNDS 119059 14415738 27262507 29560440 -2297933 16410 16410 -2281523 27190297 16410 16410 27173887 88620 88620 27262507 30355883 0 30355883 88620 -884063 -795443 29560440 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FUND ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011 THERE ARE NO UNCERTAIN POSITIONS. PART XIII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN HEALTH CLAIMS PAYABLE -54,400. DECREASE IN ACCUMULATED BENEFITS FOR PARTICIPANTS -829,663. 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: 16,410. 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. FORM 990, SCHEDULE D, PART XI, LINE 10 THE $(2,281,523) REPORTED HERE ON LINE 10 DOES NOT AGREE WITH THE NET INCREASE IN NET ASSETS AVAILABLE FOR BENEFITS PER THE AUDITED FINANCIAL STATEMENTS OF $(3,165,586). THE DIFFERENCE OF $(884,063) IS THE SUM OF THE CHANGES IN BENEFITS PAYABLE OF $(54,400) AND THE ACCUMULATED BENEFIT FOR PARTICIPANTS OF $(822,663). THESE ITEMS ARE INCLUDED IN THE FORM 990, BUT ARE ONLY DISCLOSED IN THE NOTES OF THE AUDITED FINANCIAL STATEMENTS.