2015-02-24T14:42:04-06:00 2014-05-31 470900880 CALIBRE CPA GROUP PLLC 566 WEST LAKE STREET SUITE 300 CHICAGO IL 606611414 990 2013-06-01 237166771 OPERATING ENGINEERS LOCAL 139 HEALTH BENEFIT FUND OPER 2625499190 PO BOX 160 PEWAUKEE WI 530720130 RICHARD WANTA CHAIRMAN 2625499190 2015-02-19 1 ANDY HEIN P00499757 3126550037 2013 2016-03-07 17:11:31Z RICHARD WANTA PO BOX 160 PEWAUKEE WI 530720130 203012907 0 X N/A X 1970 WI TO PROVIDED HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE PLAN. 10 10 123 0 0 -42875 0 0 97981315 105408470 12320224 11324660 0 0 110301539 116733130 0 0 92729240 99573997 0 0 0 0 0 5742227 5919156 98471467 105493153 11830072 11239977 279367253 303478184 35883749 39622339 243483504 263855845 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 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 2563 0 1 123 1 0 0 0 0 0 0 X 10 10 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 SECRETARY 3.00 40.00 X 0 171903 59190 TOM WOLF TRUSTEE 3.00 X 0 0 0 RYAN OEHLHOF FMR TRUSTEE 3.00 40.00 X 0 139792 59190 DAN SPERBERG TRUSTEE 3.00 40.00 X 0 138738 59190 TIM PETERSON TRUSTEE 3.00 X 0 0 0 JOHN TOPP TRUSTEE 3.00 40.00 X 0 138500 15235 RICHARD WANTA CHAIRMAN 3.00 40.00 X 0 46183 0 DAVID BOHL TRUSTEE 3.00 40.00 X 0 112264 21080 STEVE BUFFALO TRUSTEE 3.00 40.00 X 0 139230 59190 MARY JANE DEBATTISTA TRUSTEE 3.00 X 0 0 0 LEONARD SHELTON TRUSTEE 3.00 40.00 X 0 103992 59190 0 990602 332265 0 0 1 0 ANTHEMBCBS 4361 IRWIN SIMPSON RD MASON OH 45040 PPO ACCESS AND ADMIN 1956021 CARDAY ASSOCIATES INC N27 W23233 ROUNDY DR PEWAUKEE WI 53072 THIRD PARTY ADMIN 1665421 CASE MANAGEMENT SPECIALISTS INC PO BOX 102 NASHOTAH WI 53058 CONSULTING FEES 407446 SILVERSCRIPT INS CO PO BOX 52067 PHOENIX AZ 85072 RX ADMININSTRATION 342763 ROBERT W BAIRD & CO INC 777 EAST WISCONSIN AVE MILWAUKEE WI 53202 INVESTMENT FEES 154869 10 EMPLOYER CONTRIBUTIONS 900099 91225313 91225313 SELF-PAY CONTRIBUTIONS 900099 13698361 13698361 SUBROGATION RECOVERIES 900099 484796 484796 105408470 8709280 8709280 88895157 86279777 2615380 2615380 2615380 116733130 105408470 0 11324660 99573997 1685466 135881 26013 394498 3147978 88234 163906 184524 5973 53136 33547 105493153 3019876 2893830 10681438 12261668 47939 42570 1382414 1214746 207944 167668 258341054 280682329 4991580 5398265 2077422 2031854 279367253 303478184 418177 468780 281726 367649 35183846 38785910 35883749 39622339 X 0 0 0 0 243483504 263855845 243483504 263855845 279367253 303478184 11239977 9132364 0 X X 0 1 X 1 0 998095 958939 39156 384319 255807 128512 167668 CLAIMS PAYABLE 2209800 CLAIMS INCURRED BUT NOT REPORTED 8839000 ACCUM PART HEALTH SAV ACCOUNTS 27737110 38785910 X 125470996 9132364 9132364 116338632 394498 394498 116733130 101496591 0 101496591 394498 3602064 3996562 105493153 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, 2014, 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, 2014, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2011. PART XII, LINE 4B - OTHER ADJUSTMENTS: INC IN PART. ACCUM HEALTH REIMB ACCOUNTS 5,152,964. INC IN EST CLAIMS INCURRED BUT NOT RPTD -1,240,800. INC IN EST CLAIMS PAYABLE -310,100. 0 0 0 TERRY MCGOWAN SECRETARY 0 170975 0 0 0 928 0 35400 0 23790 0 231093 0 0 RYAN OEHLHOF FMR TRUSTEE 0 139300 0 0 0 492 0 35400 0 23790 0 198982 0 0 DAN SPERBERG TRUSTEE 0 138738 0 0 0 0 0 35400 0 23790 0 197928 0 0 JOHN TOPP TRUSTEE 0 138500 0 0 0 0 0 0 0 15235 0 153735 0 0 STEVE BUFFALO TRUSTEE 0 138984 0 0 0 246 0 35400 0 23790 0 198420 0 0 LEONARD SHELTON TRUSTEE 0 103616 0 0 0 376 0 35400 0 23790 0 163182 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 11 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 AS 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 AUGELLI 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