2017-11-14T07:47:44-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2016-01-01 366090694 BOILERMAKERS NATIONAL HEALTH & WELFARE FUND BOIL 9133426555 754 MINNESOTA AVENUE NO 110 KANSAS CITY KS 66101 RONNIE TRAXLER CHAIRMAN 9133426555 2017-11-08 1 DOUG BERTOSSI P00637990 6123764500 67.137.57.251 2017-11-08 15:40:26 CS P 662AFBF7F2F9883F5E910BA2CC57A7F69F389170 91CEC10FCE41CD9386A3334136B5DACB34123101 2016 2017-02-10 21:41:12Z RONNIE TRAXLER 754 MINNESOTA AVENUE NO 110 KANSAS CITY KS 66101 1255381373 0 X WWW.BNF-KC.COM X 1954 KS TO PROVIDE HEALTH AND WELFARE BENEFITS 15 15 0 15 0 0 0 0 262885883 251218440 28661353 53237773 320258 220165 291867494 304676378 0 0 246667369 246190945 804588 851370 0 0 0 8385306 8031596 255857263 255073911 36010231 49602467 923282168 955180857 91331175 77355659 831950993 877825198 TO PROVIDE HEALTH AND WELFARE BENEFITS 0 0 PROVIDE HEALTH AND WELFARE BENEFITS FOR PARTICIPANTS 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 12 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X TONYA PAVELAC-WALKER 9139067497 754 MINNESOTA AVENUE NO 110 KANSAS CITY KS 66101 X RONNIE TRAXLER MANAGEMENT TRUSTEE - CHAIR 2.42 40.00 X X 0 0 0 KENNETH WASILEWSKI MANAGEMENT TRUSTEE 0.04 40.00 X 0 0 0 JOHN FULTZ SEE SCHEDULE O 1.92 40.00 X X 0 0 0 PATRICK GALLAGHER SEE SCHEDULE O 2.08 40.00 X X 0 0 0 JOHN CAMMUSO MANAGEMENT TRUSTEE 0.62 40.00 X 0 0 0 J MICHAEL CARROLL MANAGEMENT TRUSTEE 1.54 40.00 X 0 0 0 MIKE DOLAN MANAGEMENT TRUSTEE 0.46 40.00 X 0 0 0 JOSEPH REYNOLDS MANAGEMENT TRUSTEE 1.12 40.00 X 0 0 0 NELSON JORDAN MANAGEMENT TRUSTEE-VICE 0.85 40.00 X X 0 0 0 MARK KEFFELER SEE SCHEDULE O 1.08 40.00 X 0 0 0 JOHN CLARK JR SEE SCHEDULE O 0.92 40.00 X 0 0 0 CLAY HERFORD SEE SCHEDULE O 0.62 40.00 X 0 0 0 JEFFREY HUGHES SEE SCHEDULE O 1.15 40.00 X 0 0 0 JOSEPH LEWANDOWSKI SEE SCHEDULE O 0.62 40.00 X 0 0 0 SHELDON TRAXLER MANAGEMENT TRUSTEE 1.69 40.00 X 0 0 0 MICHAEL WEST SEE SCHEDULE O 1.62 40.00 X 0 0 0 LORI JASPERSON CHIEF OPERATIONS OFFICER 23.30 46.70 X 63678 162929 80460 MARIO RODRIQUEZ CHIEF INVESTMENT OFFICER 10.00 40.00 X 50258 211412 75398 113936 374341 155858 0 0 1 0 CIGNA HEALTH AND LIFE INSURANCE COMPANY 900 COTTAGE GROVE RD BLOOMFIELD C BLOOMFIELD CT 06002 ADMINISTRATIVE SERVICES 10599811 WILSON-MCSHANE CORPORATION 754 MINNESOTA AVE KANSAS CITY KS 66101 MANAGEMENT SERVICES 2181548 INVESCO CORE REAL ESTATE 1101 CALIFORNIA ST SUITE 475 KANSAS CITY KS 66101 INVESTMENT MANAGER 694272 NATIONAL INVESTMENT SERVICES 777 E WISCONSIN AVE SUITE 2350 MILWAUKEE WI 53202 INVESTMENT MANAGER 521735 AMERICAN CORE REALTY FUND LLC 801 N BRAND BLVD SUITE 800 GLENDALE CA 91203 INVESTMENT MANAGER 435364 19 EMPLOYER CONTRIBUTIONS 525100 199114037 199114037 EMPLOYEE CONTRIBUTIONS 525100 46186802 46186802 PRESCRIPTION REBATES 525100 5741469 5741469 DELINQUENT EMPLOYER INTEREST 525100 186111 186111 MEDICARE SUBSIDY 525100 -9979 -9979 251218440 18222081 18222081 985720687 950704995 35015692 35015692 35015692 MISCELLANEOUS INCOME 525100 220165 220165 220165 304676378 251218440 0 53457938 X 246190945 63678 416133 170766 158264 42529 1830177 330783 371800 3603833 315390 137205 56717 39446 89381 51169 81140 TRANSITIONAL REINSURANC 1123956 JOINT COMMITTEE ON ADMI 599 255073911 109357 89463 71749247 52020512 12550000 11940000 22585 21533 2287 2287 0 0 354068675 350909660 463526142 517008581 0 21256162 23191108 923282168 955180857 2997617 2311363 4846556 4672400 83487002 70371896 91331175 77355659 X 0 0 0 0 831950993 877825198 831950993 877825198 923282168 955180857 49602467 -3728262 0 X X 0 1 X 1 0 2287 2287 0 0 LIMITED PARTNERSHIPS 79556218 F LIMITED LIABILITY COMPANIES 197915683 F 103-12 INVESTMENT ENTITIES 114984940 F COMMON COLLECTIVE TRUST 84035721 F CAYMAN ISLANDS EXEMPTED COMPANIES 40516019 C 517008581 DUE TO RELATED ORGANIZATION 2289 LIABILITY FOR SECURITIES ON LOAN 37804710 DUE TO BROKER 32443342 UNREALIZED DEPRECIATION OF FUTURES CONTRACTS 121555 70371896 X 297344283 -3728262 -3728262 301072545 3603833 3603833 304676378 251470078 0 251470078 3603833 3603833 255073911 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE FUND TO HOLD THE FUND'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) UNDER THE INTERNAL REVENUE CODE (IRC) AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE TRUST OBTAINED ITS LATEST TAX EXEMPTION LETTER, DATED APRIL 25, 1968, IN WHICH THE INTERNAL REVENUE SERVICE STATED THAT THE TRUST, AS THEN DESIGNED, WAS IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THE TRUST HAS BEEN AMENDED SINCE RECEIVING THE TAX EXEMPTION LETTER. HOWEVER, THE PLAN ADMINISTRATOR AND THE PLAN'S COUNSEL BELIEVE THAT THE TRUST IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THEREFORE, THEY BELIEVE THAT THE TRUST WAS QUALIFIED AND THE RELATED TRUST WAS TAX EXEMPT AS OF THE FINANCIAL STATEMENT DATE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 LORI JASPERSON CHIEF OPERATIONS OFFICER 54028 146076 0 0 9650 16853 19342 52296 2382 6440 85402 221665 0 0 MARIO RODRIQUEZ CHIEF INVESTMENT OFFICER 43244 184356 0 0 7014 27056 12649 53927 1676 7146 64583 272485 0 0 PART I, LINE 3 THE RELATED ORGANIZATION USED THE FOLLOWING METHODS TO DETERMINE COMPENSATION: WRITTEN EMPLOYMENT CONTRACT AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7A THE BARGAINING ORGANIZATIONS, THE EMPLOYER AND UNION, BOTH APPOINT 50% OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B COPIES OF FORM 990 WERE PROVIDED TO THE GOVERNING BODY MEMBERS BY EMAIL PRIOR TO THE FORM 990 BEING FILED, AND IS REVIEWED BY TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION DOES REQUIRE ANNUAL DISCLOSURES FOR POTENTIAL CONFLICTS OF INTEREST OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST, WHICH ARE REVIEWED BY THE ORGANIZATION. THE AFFECTED TRUSTEE OR EMPLOYEE MUST CEASE PARTICIPATION IN THE DECISION OR TRANSACTION UNTIL IT IS DETERMINED THAT THE AFFECTED TRUSTEE OR EMPLOYEE MAY CONTINUE TO PARTICIPATE IN THE DECISION OR TRANSACTION. POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE ALSO REVIEWED FOR COMPLIANCE WITH ERISA REQUIREMENTS. THE ORGANIZATION DOES REQUIRE FULL DISCLOSURE FOR POTENTIAL CONFLICTS OF INTEREST WHEN CONDUCTING SEARCHES FOR NEW VENDORS AND SERVICE PROVIDERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A THE FOLLOWING TRUSTEES ARE COMPENSATED BY A NON-PROFIT RELATED ORGANIZATION AND COMPENSATION INFORMATION WILL BE MADE AVAILABLE UPON REQUEST. JOHN T. FULTZ, UNION TRUSTEE - SECRETARY PATRICK M. GALLAGHER, UNION TRUSTEE - ASST. SECRETARY MARK KEFFELER, UNION TRUSTEE JOHN CLARK JR., UNION TRUSTEE CLAY HERFORD, UNION TRUSTEE JEFFREY HUGHES, UNION TRUSTEE JOSEPH LEWANDOWSKI, UNION TRUSTEE MICHAEL WEST, UNION TRUSTEE FORM 990, PART IX, LINE 11A FEES ARE PAID TO A THIRD PARTY ADMINISTRATOR FOR ADMINISTRATION TO THE FUND. PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. BOILERMAKERS LOCAL 1 SOUTHEAST DISTRICT LODGE 3 BOILERMAKERS L 4 NAVAJO NATION BOILERMAKERS LOCAL 5 BOILERMAKERS LOCAL 7 BOILERMAKERS LOCAL 11 BOILERMAKERS LOCAL 13 BOILERMAKERS LOCAL 26 BOILERMAKERS LOCAL 27 BOILERMAKERS LOCAL 28 BOILERMAKERS LOCAL 29 BOILERMAKERS LOCAL 37 BOILERMAKERS LOCAL 40 BOILERMAKERS LOCAL 45 BOILERMAKERS DISTRICT 57 BOILERMAKERS LOCAL 60 BOILERMAKERS LOCAL 69 BOILERMAKERS LOCAL 83 BOILERMAKERS LOCAL 85 BOILERMAKERS LOCAL 92 BOILERMAKERS LOCAL 101 BOILERMAKERS LOCAL 105 BOILERMAKERS LOCAL 107 BOILERMAKERS LOCAL 108 BOILERMAKERS LOCAL 110 BOILERMAKERS LOCAL 154 BOILERMAKERS LOCAL 169 BOILERMAKERS LOCAL 193 BOILERMAKERS LOCAL 237 BOILERMAKERS LOCAL 242 BOILERMAKERS LOCAL 363 BOILERMAKERS LOCAL 374 BOILERMAKERS LOCAL 433 BOILERMAKERS LOCAL 454 BOILERMAKER LOCAL 455 BOILERMAKERS LOCAL 456 BOILERMAKERS LOCAL 502 BOILERMAKERS LOCAL 549 BOILERMAKERS LOCAL 627 BOILERMAKERS LOCAL 647 BOILERMAKERS LOCAL 667 BOILERMAKERS LOCAL 693 BOILERMAKERS LOCAL 744 LOCAL 107 DEVELOP 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