2019-05-31T09:17:56-05:00 2018-08-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2017-09-01 237422786 WISCONSIN MASONS HEALTH CARE FUND WISC 8003625474 2901 W BELTLINE HIGHWAY NO 100 MADISON WI 537134226 DAVE HAHN CHAIRMAN 8003625474 2019-05-28 1 THOMAS M POWERS CPA P00241729 2627846210 70.61.53.194 2019-05-28 12:03:16 CD P CCA3FFBDE7687CE42E9EA09D506C5024DA3E21F0 E6222CC25829A20C3D9794B5F0F2CFDF74A758A1 2017 2019-02-21 02:37:17Z DAVE HAHN 2233 BIRCH STREET EAU CLAIRE WI 54703 41809831 0 X N/A X 1973 WI TO PROVIDE HEALTH, LIFE, DENTAL, AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS, SPOUSES, AND DEPENDENTS. 20 20 66 0 0 0 0 0 23978917 26596025 579576 947121 55616 1661350 24614109 29204496 0 0 22852934 29194196 0 0 0 0 0 2755122 2719833 25608056 31914029 -993947 -2709533 20859429 20621432 11395202 14078833 9464227 6542599 SEE BELOW 0 0 30322553 TO PROVIDE HEALTH, LIFE, DENTAL, AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS, SPOUSES, AND DEPENDENTS. 30322553 0 0 0 0 0 0 0 0 0 0 0 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 1 241 0 1 66 1 0 0 0 0 0 0 0 0 X 20 20 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X BENEFIT PLAN ADMINISTRATION 8003625474 2901 W BELTLINE HWY SUITE 100 MADISON WI 537134226 DAVID HAHN CHAIRMAN 0.00 2.00 X X 0 0 0 RANDY WEYTENS TRUSTEE 1.00 40.00 X 0 85525 62335 WYNN JONES TRUSTEE 1.00 40.00 X 0 85525 62335 PATRICK WHITING TRUSTEE 0.00 X 0 0 0 JEFF LECKWEE VICE-CHAIRMAN 0.00 X X 0 0 0 JERRY SHEA TRUSTEE 0.00 X 0 0 0 BARRY SCHOLZ SECRETARY-TREASURER 0.00 X X 0 0 0 GARY BURNS TRUSTEE 1.00 40.00 X 0 92498 64687 DAVID BOHL TRUSTEE 0.00 X 0 0 0 JEFF STAVER TRUSTEE 0.00 X 0 0 0 DAN DOPERALSKI TRUSTEE - PAST 1.00 42.00 X 0 48519 46200 DEAN BASTEN TRUSTEE 0.00 X 0 0 0 LARRY RASCH TRUSTEE 0.00 X 0 0 0 JASON MATTILA TRUSTEE 0.00 X 0 0 0 JIM VICK TRUSTEE 1.00 40.00 X 0 84696 62966 MATT QUASIUS TRUSTEE 0.00 X 0 0 0 JOHN TOPP TRUSTEE 0.00 X 0 0 0 WILLIAM BONLENDER TRUSTEE 1.00 40.00 X 0 84590 62042 MIKE HYATT TRUSTEE 1.00 40.00 X 0 87821 61074 TOBIN BOYLE TRUSTEE 1.00 40.00 X 0 83024 63464 TODD GRAY TRUSTEE - NEW 1.00 42.00 X 0 85021 57813 0 737219 542916 0 0 1 0 BENEFIT PLAN ADMINISTRATION 2901 WEST BELTLINE HIGHWAY SUITE 1 MADISON WI 53713 CONTRACT ADMINISTRATION 1060710 UNITED HEALTHCARE INSURANCE COMPANY PO BOX 88822 MILWAUKEE WI 53228 CLAIMS / PPO EXPENSE 810357 MERCER HEALTH & BENEFITS LLC 155 NORTH WACKER DRIVE STE 1500 CHICAGO IL 60606 CONSULTING 198290 US BANK NATIONAL ASSOCIATION PO BOX 1800 SAINT PAUL MN 55101 BANKING / INVESTMENTS 115811 4 EMPLOYER CONTRIBUTIONS 900099 23799808 23799808 SELF PAY CONTRIBUTIONS 900099 2796217 2796217 26596025 368150 368150 13184306 12605335 578971 578971 578971 STOP LOSS 900099 1212133 1212133 SUBROGATION 900099 254883 254883 CLASS ACTION SETTLEMENT 900099 154596 154596 39738 39738 1661350 29204496 28836346 0 368150 29194196 29194196 938757 938757 103194 103194 26725 26725 38433 38433 233365 233365 138257 138257 53936 53936 28732 28732 9104 9104 COST CONTAINMENT 990981 990981 STOP-LOSS PREMIUMS 114526 114526 BIOMETRIC EXPENSE 22850 22850 STORAGE EXPENSE 16733 16733 4240 4240 31914029 30322553 1591476 0 2011 887 2158811 1834663 3592084 4992932 187924 175273 14918599 13617677 20859429 20621432 456880 326301 26951 26497 10911371 13726035 11395202 14078833 X 0 0 0 0 9464227 6542599 9464227 6542599 20859429 20621432 -2709533 -212095 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE 3842135 MEMBER DOLLAR BANK 9883900 13726035 X 28953968 -212095 -212095 29166063 38433 38433 29204496 28475461 0 28475461 38433 3400135 3438568 31914029 PART X, LINE 2: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN CLAIMS PAYABLE/IBNR 3,400,135. 0 0 0 GARY BURNS TRUSTEE 0 92498 0 0 0 0 0 0 0 64687 0 157185 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE OFFICERS AND ADMINISTRATIVE MANAGER REVIEWS THE FORM 990 WITH THE ACCOUNTANT BEFORE SIGNING AND MAKING A COPY OF THE FORM 990 AVAILABLE FOR ALL TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C THERE ARE ANNUAL TRUSTEE QUESTIONNAIRES. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT TO PERFORM THE AUDIT OF THE PLAN'S FINANCIAL STATEMENTS. FORM 990, SCHEDULE R: THE PLAN MADE A REASONABLE EFFORT TO OBTAIN THE FEDERAL TAX CLASSIFICATION FROM ALL CONTRIBUTING EMPLOYERS BUT WAS UNABLE TO OBTAIN A RESPONSE FROM 35 EMPLOYERS. 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