2023-03-29T17:03:44-05:00 2022-05-31 470900880 CALIBRE CPA GROUP PLLC 230 W MONROE STE 310 CHICAGO IL 60606 990 2021-06-01 237166771 OPERATING ENGINEERS LOCAL 139 HEALTH BENEFIT FUND OPER 2625499190 PO BOX 160 PEWAUKEE WI 530720130 TERRANCE MCGOWAN CHAIRMAN 2625499190 2023-03-27 1 TERRANCE MCGOWAN 999009999 ANDY HEIN P00499757 3126550037 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z TERRANCE MCGOWAN PO BOX 160 PEWAUKEE WI 530720130 504506709 0 X N/A X 1970 WI TO PROVIDED HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN. 10 6 150 0 0 0 0 0 136314725 141687747 23002083 54576864 0 0 159316808 196264611 0 0 142665755 137130524 0 0 0 0 0 7992923 8505585 150658678 145636109 8658130 50628502 462021305 445469053 77088691 78780624 384932614 366688429 X TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN 0 0 THE PLAN PROVIDES MEDICAL, DENTAL, VISION, LIFE AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. THE PLAN PROVIDES MEDICAL, DENTAL, VISION, LIFE, AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 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 1 2356 0 1 150 1 0 0 0 0 0 0 0 0 X 10 6 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X CARDAY ASSOCIATES 2625499190 N27 W23233 ROUNDY DRIVE PEWAUKEE WI 530720130 TERRY MCGOWAN CHAIRMAN 3.00 40.00 X 0 197440 77545 TOM WOLF SECRETARY 3.00 X 0 0 0 DAN SPERBERG TRUSTEE 3.00 40.00 X 0 165730 77545 TIM PETERSON TRUSTEE 3.00 X 0 0 0 MATT MARCELLIS TRUSTEE 3.00 X 0 0 0 STEVE BUFFALO TRUSTEE 3.00 40.00 X 0 166049 77545 MARY JANE DEBATTISTA TRUSTEE 3.00 X 0 0 0 MARY WILCOX TRUSTEE 3.00 X 0 0 0 SHANE GRIESBACH TRUSTEE 3.00 40.00 X 0 165484 77545 DERECK ALLEN TRUSTEE 3.00 X 0 0 0 0 694703 310180 0 0 1 0 ANTHEMBCBS 4361 IRWIN SIMPSON RD MASON OH 45040 PPO ACCESS AND ADMIN 3011742 CARDAY ASSOCIATES INC N27 W23233 ROUNDY DR PEWAUKEE WI 53072 THIRD PARTY ADMIN 1761960 CASE MANAGEMENT SPECIALISTS INC PO BOX 102 NASHOTAH WI 53058 CONSULTING FEES 680279 SEGAL 101 NORTH WACKER DR STE 500 CHICAGO IL 60606 CONSULTING FEES 309716 OPTUMRX 3000 SOUTH LENOLA RD MAPLE SHADE NJ 08052 RX ADMINISTRATION 224717 12 EMPLOYER CONTRIBUTIONS 900099 122572823 122572823 SELF-PAY CONTRIBUTIONS 900099 17770108 17770108 COBRA PREMIUM ASSISTANCE 900099 776445 776445 SUBROGATION RECOVERIES 900099 568371 568371 141687747 6219877 6219877 356599085 308242098 48356987 48356987 48356987 196264611 141687747 0 54576864 137130524 1762471 223739 33785 1124351 4439042 342660 278369 167100 4688 30265 51310 PCORI FEES 47805 145636109 4914501 4557776 15338342 14678349 44215 57449 1167420 1089146 85892 78274 331123906 288225028 104558446 130313631 5956003 7558546 462021305 445469053 552721 623224 1420444 1460013 75115526 76697387 77088691 78780624 X 0 0 0 0 384932614 366688429 384932614 366688429 462021305 445469053 50628502 -68872687 0 X X 0 1 X 1 0 898262 838775 59487 269158 250371 18787 78274 REAL ESTATE INVESTMENT TRUST 39017766 F LIMITED PARTNERSHIPS 53631525 F COMMON COLLECTIVE TRUST 37664340 F 130313631 CLAIMS INCURRED BUT NOT REPORTED 11700200 ACCUM PART HEALTH SAV ACCOUNTS 64997187 76697387 X 126267573 -68872687 -68872687 195140260 1124351 1124351 196264611 142801545 0 142801545 1124351 1710213 2834564 145636109 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C) 9 OF THE INTERNAL REVENUE CODE AS A TAX-EXEMPT ORGANIZATION. THE PLAN HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE, AND THE PLAN SPONSOR BELIEVES THAT THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE INTERNAL REVENUE CODE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES. AS OF MAY 31, 2022, THERE WERE 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. AT MAY 31, 2022, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2019. . PART XII, LINE 4B - OTHER ADJUSTMENTS: INC IN PART. ACCUM HEALTH REIMB ACCOUNTS 4,215,513. INC IN EST CLAIMS INCURRED BUT NOT RPTD -2,004,200. INC IN EST CLAIMS PAYABLE -501,100. 0 0 0 TERRY MCGOWAN CHAIRMAN 0 195244 0 1015 0 1181 0 51884 0 25661 0 274985 0 0 STEVE BUFFALO TRUSTEE 0 163935 0 1522 0 592 0 51884 0 25661 0 243594 0 0 DAN SPERBERG TRUSTEE 0 163935 0 1015 0 780 0 51884 0 25661 0 243275 0 0 SHANE GRIESBACH TRUSTEE 0 163935 0 1015 0 534 0 51884 0 25661 0 243029 0 0 FORM 990, PART VI, SECTION A, LINE 3 LINE 3 EXPLANATION - IN ACCORDANCE WITH THE PLAN'S TRUST AGREEMENT, THE TRUSTEES HAVE CONTRACTED THE SERVICES OF A THRID PARTY ADMINISTRATOR, CARDAY ASSOCIATES. THE THIRD PARTY ADMINISTRATOR, UNDER THE DIRECTION OF THE TRUSTEES, ADMINISTERS THE OFFICES OF THE TRUST FUND. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF TRUSTEES HAVE AUTHORIZED DESIGNATED TRUSTEES (THE CHAIRMAN AND/OR SECRETARY TRESURER) TO REVIEW THE FORM 990 PRIOR TO FILING. A COPY OF THE FILED RETURN IS MADE AVAILABLE TO ALL TRUSTEES TO REVIEW SUBSEQUENT TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ACTIONS OF THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND ERISA. BOTH ESTABLISH STANDARDS OF CONDUCT FOR PLAN FIDUCIARIES. THE TRUSTEES ARE REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST TO THE ENTIRE BOARD. FORM 990, PART VI, SECTION C, LINE 19 A SUMMARY ANNUAL REPORT IS DISTRIBUTED TO ALL PARTICIPANTS. PARTICIPANTS ARE ABLE TO REQUEST THE AUDITOR'S REPORT AND OTHER FINANCIAL INFORMATION FROM THE PLAN ADMINISTRATOR AND/OR THE U.S. DEPARTMENT OF LABOR. ALSO, FORM 5500 IS OPEN TO PUBLIC INSPECTION THROUGH THE U.S. DEPARTMENT OF LABOR. FORM 990, PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. WIS OPER ENG SKILL IMPROVEMENT & APPRENT N27W23233 ROUNDY DR PO BOX 160 PEWAUKEE WI 53072 391102559 TRAINING FUND WI 501(C)(3) LINE_2_SCHOOL_DESCRI 0 LMCT OF OPERATING ENGINEERS LOCAL 139 N27W23233 ROUNDY DR PO BOX 160 PEWAUKEE WI 53072 364656562 INDUSTRY ADVANCEMENT FUND WI 501(C)(5) 0 ALLIED CONST EMP ASSN 17100 W BLUEMOUND RD 102 BROOKFIELD WI 53005 390189310 CONTRACTORS ASSOCIATION WI 501(C)(6) 0 CONSTRUCTION BUS GROUP 4702 S BILTMORE LN MADISON WI 53718 391703979 INDUSTRY ADVANCEMENT FUND WI 501(C)(5) 0 INTL UN OPER ENG 139 N27W23233 ROUNDY DR PEWAUKEE WI 53072 390368025 LABOR UNION WI 501(C)(5) 0 WI UNDERGRD CONTR ASSSOC 2835 NORTH MAYFAIR RD MILWAUKEE WI 53222 390745462 CONTRACTORS ASSOCIATION WI 501(C)(6) 0 ASSOCIATED GENERAL CONTRACTORS OF WISCONSIN 4814 EAST BROADWAY MADISON WI 53716 390712400 CONTRACTORS ASSOCIATION WI 501(C)(6) 0 WISCONSIN TRANSPORTATION BUILDERS ASSOCIATION INC 1 S PINCKNEY ST NO 300 MADISON WI 53703 390138120 CONTRACTORS ASSOCIATION WI 501(C)(6) 0 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