2020-06-03T11:22:05-05:00 2019-08-31 470900880 CALIBRE CPA GROUP PLLC 230 W Monroe Street CHICAGO IL 60606 990 2018-09-01 237009055 WISCONSIN LABORERS' HEALTH FUND WISC 6088461742 4633 LIUNA WAY No 201 DEFOREST WI 535322514 john schmitt Trustee 6088461742 2020-06-03 1 COREY BILKEY P00499751 3126550037 38.100.43.98 2020-06-03 11:21:57 CD P 099BB351ED5C43DB8E4A0DD96B056B1430213725 2A1264631413402ED07D1720FD2C9A4C172C9560 2018 2021-09-10 13:11:23Z 4633 LIUNA WAY No 201 DEFOREST WI 535322514 125270450 0 X N/A X 1967 WI TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN. 14 5 173 0 0 0 0 0 94393063 93304487 3780121 4415411 0 0 98173184 97719898 0 0 85871183 92910972 46843 51570 0 0 0 6581027 6868795 92499053 99831337 5674131 -2111439 302142419 308332507 46596472 48037253 255545947 260295254 X TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN. 0 0 THE PLAN PROVIDES HOSPITAL, MEDICAL, SURGICAL, DENTAL, VISION, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, DISABILITY, AND SKILLED NURSING CARE BENEFITS TO ALL ELIGIBLE PARTICIPANTS. THE PLAN PROVIDES HOSPITAL,MEDICAL, SURGICAL, DENTAL, VISION, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, DISABILITY, AND SKILLED NURSING CARE BENEFITS TO ALL ELIGIBLE PARTICIPANTS. 0 0 0 0 0 0 0 0 0 0 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 0 0 173 1 0 0 0 0 0 0 0 0 X 14 5 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 X benefit plan administrators 6088461742 4633 LIUNA WAY SUITE 201 DEFOREST WI 535322514 MARY WILCOX TRUSTEE 3.00 X 0 0 0 WILLIAM KENNEDY TRUSTEE 3.00 X 0 0 0 BRIAN HORNUNG TRUSTEE 3.00 X 0 0 0 ROBERT BARKER TRUSTEE 3.00 40.00 X 0 224859 36981 JOHN TOPP TRUSTEE 3.00 40.00 X 0 177480 20047 TONY NEIRA TRUSTEE 3.00 50.00 X 0 142703 78911 CLARK JENSEN TRUSTEE 3.00 40.00 X 0 98403 59844 TONY MARCELLE TRUSTEE 3.00 40.00 X 0 91273 40894 JOHN SCHMITT TRUSTEE 3.00 40.00 X 0 154550 82270 DAVE SMESTAD TRUSTEE 3.00 X 0 0 0 KENT MILLER TRUSTEE 3.00 40.00 X 0 4452 488 KEVIN RENLEY TRUSTEE 3.00 X 0 0 0 JAMES FOYE TRUSTEE 3.00 40.00 X 0 96459 67891 BRIAN DEHNHOFF TRUSTEE 3.00 40.00 X 0 88713 62592 0 1078892 449918 0 0 1 0 ANTHEM BLUE CROSS BLUE SHIELD PO BOX 34210 LOUISVILLE KY 40233 PPO SERVICE FEES 2155049 BENEFIT PLAN ADMINISTRATION OF WISC 2901 WEST BELTLINE HIGHWAY MADISON WI 53713 ADMIN 1612976 DELTA DENTAL INSURANCE 2801 HOOVER ROAD PO BOX 828 STEVENS POINT WI 54481 DENTAL CLAIMS ADMINISTRATOR 234038 hmc healthworks 181 commodore dr jupiter FL 33477 biometric testing 231087 SEGAL CONSULTING 101 N WACKER DR STE 500 CHICAGO IL 60606 CONSULTING 179658 6 EMPLOYER CONTRIBUTIONS 900099 84881536 84881536 SELF-PAY CONTRIBUTIONS 900099 7599402 7599402 Subrogation 900009 791968 791968 LIQUIDATED DAMAGES 900099 31581 31581 93304487 2936818 2936818 29029145 27550552 1478593 1478593 1478593 97719898 93304487 0 4415411 92910972 51570 1751265 466801 68565 1387795 2888426 144370 93828 1173 33860 ACA FEES AND ASSESSMENT 32712 99831337 14719367 16080520 421489 833111 11849667 12731991 2928 50076868 52044864 224703080 226247103 371948 391990 302142419 308332507 3762070 4102283 42834402 43934970 46596472 48037253 X 0 0 0 0 255545947 260295254 255545947 260295254 302142419 308332507 -2111439 6860746 0 X X 0 1 X 1 0 0 COMMON COLLECTIVE TRUSTS 105294090 F POOLED SEPARATE ACCOUNTS 12433137 F LIMITED PARTNERSHIPS 62900491 F 103-12 INVESTMENT ENTITY 22542890 F REAL ESTATE INVESTMENT TRUST 23076495 F 226247103 EST FOR EXTENDED ELIG 32000000 EST FOR INCUR BUT NOT RPTD 5867000 EST FOR BANKED HOURS 250000 ACCUM BALANCE IN PART HSA ACCTS 5817970 43934970 X 103192849 6860746 6860746 96332103 1387795 1387795 97719898 96958672 0 96958672 1387795 1484870 2872665 99831337 Part X, Line 2: AS OF AUGUST 31, 2019, 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 THE TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD IN PROGRESS. AT AUGUST 31, 2019 THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED AUGUST 31, 2016. Part XII, Line 4b - Other Adjustments: DECREASE IN INBR -1,553,000. CHANGE IN ACCUM ELIGIBILITY 1,500,000. CHANGE IN CLAIMS PAYABLE 384,302. INCREASE IN BANKED HOURS 6,000. INCREASE IN PART HSA ACCUM BALANCE 1,147,568. 0 0 0 ROBERT BARKER TRUSTEE 0 224859 0 0 0 0 0 20325 0 16656 0 261840 0 0 JOHN TOPP TRUSTEE 0 177480 0 0 0 0 0 18951 0 1096 0 197527 0 0 TONY NEIRA TRUSTEE 0 142703 0 0 0 0 0 61571 0 17340 0 221614 0 0 CLARK JENSEN TRUSTEE 0 95828 0 0 0 2575 0 42348 0 17496 0 158247 0 0 JOHN SCHMITT TRUSTEE 0 150369 0 0 0 4181 0 63920 0 18350 0 236820 0 0 JAMES FOYE TRUSTEE 0 96459 0 0 0 0 0 46208 0 21683 0 164350 0 0 BRIAN DEHNHOFF TRUSTEE 0 88713 0 0 0 0 0 42964 0 19628 0 151305 0 0 Form 990, Part VI, Section B, line 11b THE TRUSTEES AUTHORIZE THE FUND'S THIRD PARTY ADMINISTRATOR AND A DESIGNATED TRUSTEE TO REVIEW THE FORM 990 BEFORE IT IS FILED. Form 990, Part VI, Section B, line 12c THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND HAVE A FIDUCIARY RESPONSIBILITY UNDER ERISA TO ADMINISTER THE PLAN IN THE BEST INTEREST OF THE MEMBERSHIP. THE US DEPARTMENT OF LABOR REQUIRES ALL LABOR TRUSTEES TO REPORT ON FORM LM-30 POTENTIAL SITUATIONS WHERE THERE MAY BE CONFLICTS OF INTEREST. THIS INFORMATION IS OPEN TO THE PUBLIC. 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 DEPARTMENT OF LABOR. ALSO, THE FORM 5500 IS OPEN TO PUBLIC INSPECTION. Form 990, Part XII, line 2c: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. WISCONSIN LABORERS PENSION FUND 4633 LIUNA WAY SUITE 201 DEFOREST WI 53532 396198530 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS WI 401 A 0 WISCONSIN LABORERS APPR & TRAINING FUND 4633 LIUNA WAY 100 DEFOREST WI 53532 391161160 TO PROVIDE TRAINING AND IMPROVE THE SKILLS OF MEMBERS WI 501C 3 0 LABORERS UNION LOCAL #464 1438 n stoughton rd madison WI 53714 390189279 improve condition of workers WI 501c5 0 LABORERS UNION LOCAL 113 6310 w appleton ave milwaukee WI 53210 390367985 improve condition of workers WI 501c5 0 LABORERS UNION LOCAL 140 2771 george st lacrosse WI 54603 390367733 improve condition of workers WI 501c5 0 LABORERS UNION LOCAL 330 886 w airport rd menasha WI 54952 201169193 improve condition of workers WI 501c5 0 LABORERS UNION-LOCAL 268 2233 birch st eau claire WI 54703 562460681 improve condition of workers WI 501c5 0 WIS LABORERS DISTRICT COUNC 4633 LIUNA WAY 100 DEFOREST WI 53532 391142477 improve condition of workers WI 501C5 0 WISCONSIN LABORERS LECET 4633 LIUNA WAY 100 DEFOREST WI 53532 391705116 improved labor mgmt cooperation WI 501c5 0 agc of wisconsin 4814 e broadway madison WI 53716 390712400 improved labor mgmt cooperation WI 501c6 0 allied construction employers assn 17100 w bluemound rd brookfield WI 53005 390189310 improved labor mgmt cooperation WI 501c6 0 A-1 EXCAVATING A&J CONCRETE SERVICES LLC AL LTD LANDSCAPING ABCO BUILDING CORP ADKINS CONSTRUCTION INC ADVANTAGE SCAFFOLDING-TRADE ACCESS AECOM ENERGY AND CONSTRUCTION INC AJ HEINEN INC ALBERICI CONSTRUCTORS INC ALBRIGHTSON EXCAVATING ALFREDSON BROTHERS CONSTRUCTION COM ALL FIVE CONCRETE CUTTING INC AMERICAN DEMOLITION CORPORATION AMERICAN SEWER SERVICES INC APCOMPOWER INC API CONSTRUCTION COMPANY INC APPLIED ECOLOGICAL SERVICE APPLIED FLOORING SOLUTIONS LLC ARBOR GREEN INC ARNIE MACKEY CONSTRUCTION INC ARROW-CRETE CONSTRUCTION LLC ARTEAGA CONSTRUCTION INC ASBESTROL INC ASC INSULATION & FIREPROOFING INC ASSOC PIPELINE CONSTRUCTION IN ASSOCIATED GENERAL CONTRACTORS ASTI 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