2013-02-14T16:29:22-06:00 2012-04-30 BENDA GRACE STULZ & COMPANY PC 38800 VAN DYKE AVE STE 100 STERLING HEIGHTS MI 48312 990 2011-05-01 381968628 MILLWRIGHTS' LOCAL 1102 HEALTH AND WELFARE FUND MILL 5173517502 6525 CENTURION DRIVE LANSING MI 489179275 FRANK BENSONTHOMAS WOODBECK 5173517502 2012-09-25 BRYAN STULZ 5868836240 2013-02-14 2011 2016-03-07 17:11:31Z 28941862 false X X 1970 MI PROVIDE HEALTH CARE BENEFITS TO ELIGIBLE PARTICIPANTS. 6 3 0 0 0 16520654 17606214 163196 -2010224 367367 -31528 17051217 15564462 0 17428802 13963601 0 0 0 187803 156306 17616605 14119907 -565388 1444555 11750398 11893206 11647289 8280531 103109 3612675 PROVIDE HEALTH CARE BENEFITS TO ELIGIBLE PARTICIPANTS. false false 13963601 TO PROVIDE HEALTH CARE BENEFITS TO ELIGIBLE PARTICIPANTS. 13963601 false false false false false false false false false false false false false true false true false false false false false false false false false false false false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false X 6 3 true false false false false false false true true false false false false false false false false false X TIC INTERNATIONAL CORPORATION 5173217502 6525 CENTURION DRIVE LANSING MI 48917 FRANK BENSON 1.00 X 0 103335 37436 KELLY JAMES RALEIGH 1.00 X 0 74613 39273 MICHAEL BARNWELL 1.00 X 0 68854 19018 THOMAS WOODBECK 1.00 X 0 0 0 JAMES SCHULTZ 1.00 X 0 0 0 DAVID HURST 1.00 X 0 0 0 GREGORY D ABBOTT 1.00 X 0 0 0 246802 95727 false false false BLUE CROSS BLUE SHIELD OF MICHIGAN 600 EAST LAFAYETTE D517 DETROIT MI 48226 HEALTH BENEFIT 924116 1 EMPLOYER CONTRIBUTIONS 238900 14208100 14208100 PARTICIPANT SELF-PAYS 900099 3398114 3398114 17606214 212419 15710 196709 11154757 13377400 -2222643 -2222643 -2222643 LIQUIDATED DAMAGES 900099 14457 14457 COBRA SUBSIDY 900099 3001 3001 MEDICARE PART D SUBSIDY 900099 -48986 -48986 -31528 15564462 15367753 196709 13963601 13963601 42474 42474 16900 16900 20785 20785 8900 8900 35026 35026 9421 9421 10387 10387 HIPAA COMPLIANCE CHARGES 7965 7965 SUMMARY ANNUAL REPORTING 4448 4448 14119907 13963601 156306 0 1777471 1184338 2540166 1691390 2730304 3083182 4702457 5934296 11750398 11893206 424289 465531 11223000 7815000 11647289 8280531 X 103109 3612675 103109 3612675 11750398 11893206 1444555 2065011 X false true true X false false false false false false false false false false false ACCUMULATED ELIGIBILITY CREDITS 6660000 CLAIMS INCURRED BUT NOT REPORTED 1155000 7815000 15564462 14119907 1444555 2065011 2065011 3509566 17608688 2065011 2065011 15543677 20785 20785 15564462 14099122 14099122 20785 20785 14119907 ADDITIONAL INFORMATION FORM 990, PART VI LINE 2 - FAMILY RELATIONSHIP OR BUSINESS RELATIONSHIP - THE RELATIONSHIP BETWEEN THE TURSTEES OF THE FUND IS AS 'BUSINESS RELATIONSHIP'. THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED. THE FUND, AS A TAFT-HARTLEY FUND, IS ADMINISTERED BY A BOARD OF TRUSTEES WHICH IS COMPOSED OF AN EQUAL NUMBER OF UNION AND EMPLOYER REPRESENTATIVES. BECAUSE OF THIS ORGANIZATIONAL REQUIREMENT, THERE IS A BUSINESS RELATIONSHIP BETWEEN THE TRUSTEES. LINE 12 - ANNUALLY, EACH TRUSTEES MUST ANSWER THE FIDUCIARY LIABILITY INSURANCE RENEWAL QUSETIONAIRE, WHICH CONTAINS QUESTIONS REGARDING POTENTIAL AND ACTUAL CONFLICTS OF INTERST. LINE 15 - THE FUND DID NOT HAVE A CEO, EXECUTIVE DIRECTOR, OR TOP MANAGEMENT OFFICIAL, OR OTHER OFFICERS OR KEY EMPLOYEES, AS THOSE TERMS ARE DEFINED. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS PRESENTED AND APPROVED AT A MEETING OF THE BOARD OF TRUSTEES, SUBJECT TO REVIEW BY AND APPROVAL OF THE FUND LEGAL COUNSEL. IN ADDITION, EACH TRUSTEES IS PROVIDED A COPY OF THE FUND'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES), AS ULTIMATELY FILED WITH THE IRS, PRIOR TO ITS FILING WITH THE IRS. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT SECURITY ACT OF 1974, AS AMENDED. IT OPERATES IN COMPLIANCE WITH THE REPORTING AND DISCLOSURE REQUIREMENTS OF SUBTITLE B, PART 1 OF ERISA WITH RESPECT TO DISCLOSURE OF ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION. IT OPERATES IN COMPLIANCE WITH THE FIDUCIARY RESPONSIBILITY REQUIREMENTS OF SUBTITLE B, PART 4 OF ERISA. THE FUND DOES NOT HAVE A CONFLICT OF INTEREST POLICY. SEE PART VII N/A false SEE PART VII N/A false false SEE PART VII N/A false false false false false false false false false false false false false false false false false false ADDITIONAL INFORMATION SCHEDULE R SCHEDULE R PARTS III IV V IDENTIFICATION OF RELATED ORGANIZATIONS THE FILING ORGANIZATION IS A MULTIEMPLOYER TRUST FUND AS DEFINED IN THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 AS AMENDED THE FUND PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS AS OF APRIL 30 2012 THERE WERE 136 CONTRIBUTING EMPLOYERS TO THE FUND UNDER THE INSTRUCTIONS TO SCHEDULE R THOSE EMPLOYERS ARE CONSIDERED RELATED ORGANIZATIONS THE FUNDS ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF ALL CONTRIBUTING EMPLOYERS INCLUDING NAMES ADDRESSES AND OTHER CONTACT INFORMATION HOWEVER THE FUND DOES NOT HAVE AND HAS NO REASONABLE WAY TO OBTAIN MUCH OF THE INFORMATION TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND THE EMPLOYERS LEGAL STRUCTURE EG CORPORATION OR PARTNERSHIP THE FOLLOWING IS A LISTING OF THOSE CONTRIBUTING EMPLOYERS WHICH IS THE EXTENT OF THE INFORMATION THE FUND HAS WITH RESPECT TO EACH EMPLOYER CONTRIBUTING EMPLOYERS COMMERCIAL CONTRACTING CORP BARTON MALOW CO DEARBORN MIDWEST CONVEYOR CO ELITE LINE SERVICES SHOP ATLANTIC PLANT MAINT INC DUKE DUKE SERVICES INC W SOULE COMPANY OVERHEAD CONVEYOR COMPANY TURBINE PROS LLC COMMERCIAL CONSTRUCTION INC ATLAS INDUSTRIAL HOLDINGS LLC AIRCO INDUSTRIAL CONTRACTORS CENTRAL CONVEYOR SHOULDICE BROTHERS INC PRO SERVICES INC CENTRAL CONVEYOR ALSO SHOP MTI GLOBAL SERVICES LESCO DESIGN MFG CO WALBRIDGE EQUIPMENT INSTALLATION HACKETT CONSTRUCTION GEM INDUSTRIAL INC MICHIGAN CARPENTERS HW FUND DEMARIA BUILDING COMPANY INC C M F GROUP METRO INDUSTRIAL CONTRACTING ARISTEO CONSTRUCTION ALBERICI CONSTRUCTORS MICHIGAN REGIONAL COUNCIL CARPENTERS WEBB JERVIS B URS ENERGY CONSTRUCTION INTERNL IND CONTR CORP AUTOMATIC SYSTEMS INC N B PROCESSING INC LIBERTY FABRICATORS INC SIEMENS PWR GNRTH SRVC CO MEYER CR SONS COMPANY JERGENS PIPING CORPORATION LAKESHORE ENGINEERING SERVICES MERIDIAN INDUSTRIAL WLDNG SR DULUTH SERVICES INC DAY ZIMMERMANN NPS AMERICAN INDUSTRIAL SUPPORT CRITTENDEN CONST CO INC WASHINGTON GROUP MILLWRIGHTS APPRENTICE SCHOOL BEN HUR CONSTRUCTION CO CARP OF W PA FRINGE BENEFIT FUNDS N K C CONVEYOR INSTALLATION CO THE STATE GROUP IND USA LIMIT HENKELS MCCOY INC BELT MAINTENANCE MIDWEST HEARTLAND HEALTH CARE FUND R M F NOOTER INC BABCOCK WILCOX CONST CO DUKE DUKE SERVICES INC CARP OF PHILADELPHIA BENEFITS CONSTR IND OF ROCKFORD BENEFIT CARPENTERS INDUSTRIAL COUNCIL MICHIGAN CARPENTERS APPR TRNG CARPS HEALTH OF KANSAS CITY INDUSTRIAL POWER SYSTEMS INC MIDAMERICAN GUNITE INC DURR SYSTEMS INC BELT MAINT MIDWEST MALACE FACILITIES SERVICES STONE WEBSTER CONSTR INDKY CARPENTERS WELFARE FUND SCHWEITZER INC MECHANICAL CONSULTANTS INC PROCESS PIPING EQUIPMENT INC OLAUGHLIN CONSTRUCTION CO MIDSOUTH CARP RC HEALTH FUND SYSTEMS ENTERPRISE CORP SECO STATE CONVEYOR SERVICE TRADEMARK INDUSTRIAL LLC HWX SERVICES LLC MILLWRIGHTS LOCAL UNION 1102 STEELCON INC OHIO CARP HEALTH WELFARE FUND INDUSTRIAL MAINTENANCE GROUP CENTRAL ILL CARPENTERS BENEFIT TEXAS CARPENTERS HEALTH FUND ALASKA CARPENTERS HEALTH INDUSTRIAL CONTRACTORS INC WOOD GROUP FIELD SERVICES OKLAHOMA ARKANSAS CARPENTERS CARPENTERS TRST OF WEST WASH FACILITIES SOLUTION CORP CONSTRUCTION INDUS HW FUND MILLWRIGHT SERVICES B P MILLWRIGHT SERVICES LLC AP COM POWER INC TX CARP MILLWRIGHTS HEALTH K C I INC MCT SERVICES LLC HAYES MECHANICAL EASTERN DIST CNCL CARP 1402 TX CARP MILLWRIGHTS BENEFITS NY CITY CARP BENEFIT FUNDS UNITED SKILLED TRADE BISMARK MANDAN CARPENTERS 1091 LOUISIANA CARP R C HEALTH FUND PRECISION COOLING TOWERS INC DUNCAN MACHINERY MOVER BOLDT COMPANY OREGONWASHINGTON CARPENTERS INTERNATIONAL COOLING TOWER WESTERN INDUSTRIAL CONTRACTORS POWER SUPPORT SERVICES INC CARPENTERS HW FOR NO CALIF PRECISE PREDICTIONS INC CUSTOM MECHANICAL CONST INC ZIGGYS MACHINERY MOVING SIMPSON IND SERVICES FATA AUTOMATION INC CONSTR INDUS HW FUND BOWEN ENGINEERING CORPORATION MARLEY COOLING TOWER COMPANY CHICAGO DC OF CARP HEALTH FUND CULVER DEVELOPMENT LLC SW OHIO RC OF CARPENTERS SO EASTERN CARP MILLWRIGHTS CARP HEALTH FUNDS CARP SO CALIFORNIA ADMIN CORP B K B CONSTRUCTION INC J S M ASSOCIATES LLC PLUMBERS STEAMFITTERS LU 247 NORTHSHORE CONSTRUCTION CO AFLAGC BUILDING TRADES PLAN ARDCO LLC ROYAL ARC WELDING CONTINENTAL IND SER SUPPLY RLC INC KVM DOOR SYSTEMS INC MACAL INC WALBRIDGE FACILITY MANAGEMENT