TY 2012 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
BLUE CROSS BLUE SHIELD OF MICHIGAN27000 W ELEVEN MILE B561SOUTHFIELDMI48034	HEALTH ADMIN.	2,883,433
TIC INTERNATIONAL CORPORATION6525 CENTURION DRIVELANSINGMI48917	ADMIN. MANAGER	836,211
LEGGHIO & ISRAEL PC306 SOUTH WASHINGTON SUITE 600ROYAL OAKMI48067	LEGAL	126,508
SEGALL BRYANT & HAMILL10 S WACKER DR 3500CHICAGOIL60606	INVEST CONSULT	110,278

2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 4

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	3,169,177	1	3,679,121
2	Savings and temporary cash investments .........	3,540,390	2	2,308,887
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	5,752,351	4	6,753,916
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............		8
9	Prepaid expenses and deferred charges ..........	1,787,338	9	1,716,968
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation .....	10b			10c
11	Investments—publicly traded securities ..........	59,596,181	11	64,112,811
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........		15
16	Total assets. Add lines 1 through 15 (must equal line 34)......	73,845,437	16	78,571,703
	17	Accounts payable and accrued expenses .........	876,907	17	1,265,760
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	16,993,000	25	18,258,000
26	Total liabilities. Add lines 17 through 25.........	17,869,907	26	19,523,760
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............		27
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds	55,975,530	32	59,047,943
33	Total net assets or fund balances ...........	55,975,530	33	59,047,943
34	Total liabilities and net assets/fund balances ........	73,845,437	34	78,571,703

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MICHIGAN LABORERS HEALTH AND
WELFARE FUND

Employer identification number

38-6058384

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................
b	Buildings ................
c	Leasehold improvements ............
d	Equipment ................
e	Other .................
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......

Schedule D (Form 990) 2012

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
ELIGIBITY CREDITS		16,015,000
BENEFIT CLAIMS PAYABLE		2,243,000







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		18,258,000
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	50,576,846
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	-1,641,541
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	-1,641,541
3	Subtract line 2e from line 1.....................			3	52,218,387
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	178,493
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................			4c	178,493
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	52,396,880

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........			1	47,504,433
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................			2e
3	Subtract line 2e from line 1.....................			3	47,504,433
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	178,493
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................			4c	178,493
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	47,682,926

Part XIII

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MICHIGAN LABORERS HEALTH AND
WELFARE FUND

Employer identification number

38-6058384

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2012

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)ALEX ZUREKTRUSTEE	(i) (ii)	158,540			29,049		187,589
(2)GENO ALESSANDRINISECRETARY	(i) (ii)	158,383			29,049		187,432

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Identifier	Return Reference	Explanation

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

MICHIGAN LABORERS HEALTH AND
WELFARE FUND

Employer identification number

38-6058384

Identifier	Return Reference	Explanation
ADDITIONAL INFORMATION	FORM 990, PART VI	LINE 2 - FAMILY RELATIONSHIP OR BUSINESS RELATIONSHIP - THE RELATIONSHIP BETWEEN THE TRUSTEES OF THE FUND IS A "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 ADMINSTERED BY A BOARD OF TRUSTEES WHICH IS COMPOSED OF AN EQUAL NUMBER OF UNION AND EMPLOYER REPRESENTATIVES, AND BECAUSE OF THIS ORGANIZATIONAL REQUIREMENT, THERE IS A BUSINESS RELATIONSHIP BETWEEN THE TRUSTEES.
ELECTION OF MEMBERS AND THEIR RIGHTS	FORM 990, PAGE 6, PART VI, LINE 7A	ALL BOARD MEMBERS ARE ELECTED BY THE MEMBERSHIP INTO THEIR OFFICER POSITIONS.
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 TRUSTEES, SUBJECT TO REVIEW AND APPROVAL BY THE FUND ATTORNEY.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	ANNUALLY, EACH TRUSTEE MUST ANSWER THE FIDUCIARY LIABILITY INSURANCE RENEWAL QUESTIONAIRE, WHICH CONTAINS QUESTIONS REGARDING POTENIAL AND ACUTAL CONFLICTS OF INTEREST.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE FUND DID NOT HAVE ANY EMPLOYEES WHO MET THE DEFINITIONS IN THE PLAN YEAR. IF THE FUND DID HAVE EMPLOYEES THAT MET THE LISTED DEFINITIONS, THEN ANY COMPENSATION WOULD HAVE BEEN ESTABLISHED IN ACCORDANCE WITH THE PROCESS DESCRIBED IN PART VI, LINE 15A OF FORM 990.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	THE FUND DID NOT HAVE ANY EMPLOYEES WHO MET THE DEFINITIONS IN THE PLAN YEAR. IF THE FUND DID HAVE EMPLOYEES THAT MET THE LISTED DEFINITIONS, THEN ANY COMPENSATION WOULD HAVE BEEN ESTABLISHED IN ACCORDANCE WITH THE PROCESS DESCRIBED IN PART VI, LINE 15B OF FORM 990.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED. IT OPERATES IN COMPLIANCE WITH THE REPORTING AND DISCLOSURE REQUIREMENTS OF SUBTITLE B, PART I 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.
ADDITIONAL INFORMATION	FORM 990, PART VII	LINE 1A - GENO ALESSANDRINI, ALEX ZUREK, MICHAEL AARON, JOSEPH GALLINO, DAN HUSTED AND ROBERT MALCOLM SERVED AS TRUSTEES OF THE FUND WITHOUT COMPENSATION FROM THE FUND FOR THOSE SERVICES. HOWEVER, THEY WERE COMPENSATED AS EMPLOYEES OF MICHIGAN LABORERS DISTRICT COUNCIL, LABORERS LOCAL 1191, LABORERS LOCAL 1075, AND LABORERS LOCAL 499, RESPECTIVELY, WHICH WERE CONTRIBUTING EMPLOYERS TO THE FUND, AND AS SUCH, "RELATED ORGANIZATIONS" AS THAT TERM IS DEFINED IN THE INSTRUCTIONS.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

MICHIGAN LABORERS HEALTH AND
WELFARE FUND

Employer identification number

38-6058384

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) MICHIGAN LABORERS ANNUITY FUND 6525 CENTURIAN DRIVE LANSING,MI48917 38-3345443	PENSION	MI	401A		N/A		No
(2) MICHIGAN LABORERS VACATION FUND 6525 CENTURIAN DRIVE LANSING,MI48917 38-2106864	VACATION	MI	501C9		N/A		No
(3) MICHIGAN LABOERS PENSION FUND 6525 CENTURIAN DRIVE LANSING,MI48917 38-6233976	PENSION	MI	401A		N/A		No
(4) MICHIGAN LABORERS EXCESS FUND 6525 CENTURIAN DRIVE LANSING,MI48917 38-3502493	PENSION	MI	402B		N/A		No
(5) MICHIGAN LABORERS LMT FUND 6525 CENTURIAN DRIVE LANSING,MI48917 38-3187248	LABOR MGMT	MI	501C5		N/A		No
(6) MICHIGAN LABORERS TRAINING FUND 6525 CENTURIAN DRIVE LANSING,MI48917 23-7187036	TRAINING	MI	501C3		N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) SEE PART VII			N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) SEE PART VII			N/A					No

Schedule R (Form 990) 2012

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2012

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation
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 AUGUST 31 2013 THERE WERE 560 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 THE FOLLOWING IS A LISTING OF THOSE CONTRIBUTING EMPLOYERS 1 WAY SERVICE INC 6K CONSTRUCTION COMPANY A1 UTILITY CONTRACTOR INC ABC PAVING COMPANY A PRODUCTION CLEANING API INC AARON ENTERPRISES INC ACCURATE CONC CTG CORING ACCURATE SAWING DRILLING ACE ASPHALT PAVING CO ADAMO DEMOLITION ADAMS GENERAL CONTRACTING INC AIM TECH CO LTD AJAX PAVING INDUSTRIES INC AKINS CONSTRUCTION INC ALBANELLI CEMENT CONTRACTORS ALFREDSON BROTHERS CONSTRUCTION ALL SERVICE CONTRACTORS CORP ALLAN EDWARDS CONSTR CO AMALIO CORPORATION AMBOY CONTRACTORS LLC ANLAAN CORPORATION AP COM POWER INC APEX PIPELINE SERVICES INC ARBOR CONSTRUCTION PERSONNEL ARISTEO CONSTRUCTION ARROW ACCOUSTICAL INC ARROW CONSTR R SCHEIDING ASHBAKER ALVIN MASONRY ASSOCIATED CONSTRUCTION CO ASSOCIATED PIPELINE CONTR INC ATLANTIC PLANT MAINT INC ATSALIS BROTHERS AZCO INC B B CONCRETE PLACEMENT INC B B SERVICES LLC BKB CONSTRUCTION INC B MILLER EXCAVATING INC BABCOCK WILCOX CONST CO BABCOCK UTILITIES INC BACCO CONSTRUCTION CO BAILEY EXCAVATING INC BAKER CONSTRUCTION BARNEY J J CONSTRUCTION LLC BARRETT PAVING MATERIALS INC BARTHEL CONTRACTING CO BARTON MALOW CO BASELINE CONSTRUCTORS INC BEST ASPHALT INC BIERLEIN SERVICES INC BILL HAWK INC BLATTNER ENERGY INC BLAZE CONTRACTING INC BLUE FLAME PIPELINE LLC BLUE RIBBON CONTRACTING BODDY CONSTRUCTION COMPANY BOLDT COMPANY BOOS A A SONS INC BOWEN ENGINEERING CORPORATION BP R CONST BRACY JAHR MASONRY INC BRACY DEVELOPMENT LLC BRADY SAND GRAVEL INC BRAND ENERGY SERVICES BRANDENBURG DRAINAGE INC BRANDENBURG INDUSTRIAL SERVICE BRENCAL CONTRACTORS INC BRESCOL BROTHERS INC BRINKER TEAM CONSTRUCTION CO BRIX CORPORATION BRONNER WM AND SON CONTR BRYANT ASPHALT PAVING INC BUCK CLIFFORD CONSTRUCTION CO BULLS EYE BORING INC BYERS D C COMPANY C L ENTERPRISES INC C L S CONSTRUCTION SERVICE C S S CONTRACTING CO INC CADILLAC ASPHALT LLC CAIRNS GEORGE R SONS INC CAMERON CONSTRUCTION COMPANY CANON WH INCORPORATED CARLO CONSTRUCTION INC CAROLS EXCAVATING CARRIER CONSTRUCTION CO INC CAUSIE CONTRACTING INC CBC PIPELINE LLC CENTRAL EXCAVATING LLC CENTURY CEMENT CO CERCO INC CERTIFIED ABATEMENT SERVICE CHAMPAGNE MARX EXCAVATING CHARPS WELDING FABRICATING CHRISTMAN CONSTRUCTORS INC CITY PLUMBING HEATING CO CLARK UNION SERVICES CLOGG TROY LANDSCAPE ASSOC CLOSNER CONSTRUCTION COLASANTI SPECIALTY SERVICES COMET CONTRACTING CO DEM COMET CONTRACTING CO UAP COMMERCIAL CONTRACTING CORP COMMERCIAL SPECIALTY CONT INC COMSTOCK CONSTRUCTION COMPANY CONCORD CEMENT CO INC CONCRETE CONSTRUCTORS INC CONCRETE CUTTING BKING CONST GENERAL LABORERS 1329 CONSTRUCTION LABOR SERVICES CONTEK INC CONTI CORPORATION CONTRACTING MATERIAL COMPANY CONTRACTORS RENTAL CORP COOK JACKSON CONTRACTORS COOLSAET RL CONSTRUCTION CO CORBY ENERGY CORE CONCRETE CONST INC COROTECH CONST ACQUISITION CORTIS BROS TRUCKING EXCAVAT CRACKERS EAST CORPORATION CREATIVE FLOOR COATING SYSTEMS CRITTENDEN CONST CO INC CUNNINGHAM CONSTRUCTION CO CUSACKS MASONRY RESTORATION D 2 ABATEMENT D S I ACOUSTICAL COMPANY DANS EXCAVATING INC DAVENPORT MASONRY INC DAY ZIMMERMAN NPS DAY CONSTRUCTION CO DDI INC DEMAND INDUSTRIAL LLC DEMARIA BUILDING CO DETROIT CONCRETE CONSTR INC DEVON INDUSTRIAL GROUP DICLAUDIO MASON CONTRACTORS DILISIO CONTRACTING INC DIPONIO CONSTRUCTION CO INC DIXON INCORPORATED DOAN CONSTR CO DOMINIC GAGLIO CONST INC DOUGS PLUMBING DOWNRIVER MAINTENANCE CORP DRAPER ARLAND MASONRY DUNIGAN BROS INC DUNN RITE INSTALLATION DYCON INC E L DEVELOPMENT INC E N CEMENT CO EAGLE EXCAVATION INC EATON CONSTRUCTION CO INC ECKER MECHANICAL CONTRACTORS EDWARD J PAINTING EJM PIPE SERVICES ELITE ENVIRONMENTAL ELLINGTON TRENCHLESS LLC EMPIRE REF SVC OF MICH LLC EMPIRE SOLUTIONS INC ENGLE MANAGEMENT ENVIROBATE INC ENVIRONMENTAL SPECIALTY SVCS ERICKSON LINDSTROM COM F A INDUSTRIAL SERVICES INC F M G CONCRETE CUTTING F3 FABCON INCORPORATED FASTDECKS INC FAULKNER CONSTRUCTION CO FERGUSON BLOCK CO INC FERRINI CEMENT COMPANY FESSLER BOWMAN FIORE CONSTRUCTION FISHER CONTRACTING CO FISKARS CONSTRUCTION CO INC FLORENCE CEMENT COMPANY FLYNN PAVING CO FORT WAYNE CONTRACTING INC FOULKE CONSTRUCTION CO FOUR STAR CONSTRUCTION INC FRITZELLIS CONST CO INC GCAPS JOINT VENTURE G M SONS INC G V CEMENT CONTACTING CO GABES CONSTRUCTION CO INC GAERTNER BUILDERS GALL CONSTR OF AMERICA LTD GEM INSTALLATION GEMELLI CONCRETE LLC GENESEE BAY CONSTRUCTORS INC GENESEE FENCE SUPPLY GERACE CONSTRUCTION CO INC GIBSONLEWIS GILARDONE COMPANY LLC GLASSROCKOMI GLOBAL ENVIRONMENTAL SOLUTIONS GOUGH INC GOULD PETE SONS INC GRADEL GEORGE CO GRAND RIVER CONSTRUCTION INC GRANGER CONSTRUCTION CO GRATTON CONSTRUCTION CO INC GREAT LAKES CEILING CARP INC GREAT LAKES EXCAVATING INC GREAT LAKES REG ORGANIZING GREEN EARTH ENVIRONMENTAL GREEN THUMB LAWNSCAPING INC GUNDLACH CHAMPION INC H D MANPOWER RIETH RILEY H E R CONSTRUCTION HACKETT CONSTRUCTION HAMON CUSTODIS INC HANSCHMANN MASONRY HARDMAN CONSTRUCTION INC HARMON CONSTRUCTION INC HARSCO INFRA FKA PATENT CONST HART ASSOCIATES CONSTRUCTION HAYES MECHANICAL HAYNES CONSTRUCTION INC HEBERT CONSTRUCTION COMPANY HEINEMAN J R SONS INC HENDRICK RC AND SONS INC HENKELS MCCOY INC HIGGINS DOUGLAS INC HIGHWAY LANDSCAPERS INC HIGHWAY SERVICE CO INC HMCHICKS MASON CONTRACTORS HOFFMAN BROTHERS INC HOLLY J C CONTRACTING HOOVER CONSTRUCTION CO HOOVER WELLS LLC HORNING RH SONS EXC HUGHES C D INC HULL CA INC HUNTER MODULAR CONST HUNTER PRELL COMPANY HYDAKERWHEATLAKE CO THE IAFRATE ANGELO CONSTRUCTION ICARUS INDUSTRIAL CONSTRUCTION CO IDEAL CONTRACTING IMPERIAL CONSTRUCTION CO IMPERIAL CRANE SERVICES INC INDIANHEAD PIPELINE SERVICES INDUSTRIAL FIREBRICK CORP INDUSTRIAL MAINTENANCE SERVICE INFRASOURCE UNDERGROUND INLAND LAKES LANDSCAPING CORP INTEGRITY INTERIORS INC INTEGRITY KOKOSING PIPELINE SE INTERCON CONSTRUCTION INTERNATIONAL CHIMNEY CORP INTERNATIONAL COOLING TOWER INTERNATIONAL IND CONTR CORP INTERSTATE HIGHWAY CONST CO INTREN INC IRISH CONSTRUCTION CO INC J J WHITE INC J WOOD CONTRACTING LLC JAY DEE CONTRACTORS INC JERGENS PIPING CORPORATION JOHNSON SERENUS SON CONST K M CONSTRUCTION KALENHBORN ARBESIST CORPORATION KALTZ EXCAVATING CO KENT POWER SERVICES INC KING MASONRY INC KISER HYDRO LLC KOCH MASONRY INC KORNEFFEL EC COMPANY KRIEGHOFF LENAWEE COMPANY KRULL CONSTRUCTION CO INC K S ENERGY SERVICES KULBACKI INC L L CONSTRUCTION CO INC L A CONSTRUCTION CORPORATION LABOR SERVICES LLC LABORERS 1098 LABORERS L 1191 LABORERS LOCAL 1075 LABORERS LOCAL 355 LABORERS LOCAL 499 LAKESHORE ENGINEERING SERVICES LAMB LW INC LANEY DIRECTIONAL DRILLING CO LAPINE R W COMPANY INC LARXONDANIELSON CONSTRUCTION LATEX CONSTRUCTION CO LDJ ASSOCIATES INC LEIDAL HART MASON CONTGRACTOR LESCO DESIGN MFG CO LEWIS CONSTRUCTION INC LINDBERG A SONS LJH CONSTRUCTION LLC LOWE CONSTRUCTION CO INC LUNDA CONSTRUCTION COMPANY M B CONTRACTING INC M M EXCAVATING INC M LUKAS CO M U E INC MACRO D CONTRACTORS MAJOR CEMENT CO MANFREDI CONSTRUCTION INC MANISTEE WELDING PIPING MARCY CONSTRUCTION COMPANY MARLEY COOLING TOWER CO MARRANCA CONTRACTING INC MARTELL ELECTRIC LLC MARX CONTRACTING INC MASONRY DEVELOPERS INC MATHY CONSTRUCTION CO MAVERICK CONSTRUCTION INC MCINTOSH GEORGE INC MCM MANAGEMENT CORP MCMATH MASONRY INC MDS BORING AND DRILLING INC MECHANICAL INDUSTRIAL INSUL MERIDIAN RESTORATION LLC METALLIZER OF MID AMERICA INC MEYER C R SONS COMPANY MI LABRSEMPLRS COOP EDU MICH LABORERS TRAINING AND EDU MICHAEL ANDREWS CONCRETE LLC MICHELS CORPORATION MICHELS PIPE LINE CONST MICHIGAN FENCE CO INC MICHIGAN LABORERS DIST COUNCIL MICHIGAN LABORERS JDC MICHIGAN MECHANICAL ABATEMENT MICHIGAN PAVING MATERIALS CO MICRO SURFACING INC MID AMERICAN CONSTR SERV MID MICHIGAN CONST CLEANING MIDOHIO CONTRACTING INC MIDWEST INDUSTRIAL SERVICES MIDWESTERN CONTRACTORS DIV OF ECC MILBOCKER SONS INC MILLER BROTHERS CONST INC MILLER PIPELINE CORPORATION MINNESOTA LIMITED INC MIRON CONSTRUCTION CO INC MIS CORPORATION MICHIGAN MIS INDUSTRIAL MAINTENANCE MONARCH WELDING ENG INC MONTHLY INTEREST ADJ MOORETROSPER CONSTRUCTION CO MORELLI G R CO MORRIS RL SONS CONST MRT ENVIRONMENHTAL INC MUSSON BROTHERS INC MUSSON C CONSTRUCTION N B PROCESSING INC NAGLE PAVING CO NASHVILLE CONSTRUCTION CO NATIONAL ACIDPROOFING INC NATIONAL ENVIRONMENTAL GROUP NATIONAL MICROBIOLOGICAL MNGMT NAVETTA MASON CONTRACTORS INC NEDROW REFRACTORIES NEHMIAH MASONRY NESS ROY CONT SALES NEWKIRK ELECTRIC ASSOCIATES NEXT GENERATION ENVIRONMENTAL NICHOLSON CONSTRUCTION NIELSEN COMMERCIAL CONST CO NOMAD PIPELINE SERVICES LLC NORTH AMERICAN DISMANTLING NORTH CHANNEL CONST CO INC NORTHERN CLEARING INC NORTHERN CONCR

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROVIDE HEALTH AND WELFARE BENEFITS
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	1
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		0
9	Program service revenue (Part VIII, line 2g) .........	48,118,695	49,274,267
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,410,210	2,772,332
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	352,797	350,281
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	50,881,702	52,396,880
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	42,680,878	43,159,883
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)		0
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	1,748,844	4,523,043
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	44,429,722	47,682,926
19	Revenue less expenses. Subtract line 18 from line 12.......	6,451,980	4,713,954
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	73,845,437	78,571,703
21	Total liabilities (Part X, line 26).............	17,869,907	19,523,760
22	Net assets or fund balances. Subtract line 21 from line 20.....	55,975,530	59,047,943

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	TO PROVIDE HOSPITALIZATION, MEDICAL, DEATH, SURGICAL AND OTHER HEALTH CARE BENEFITS TO ELIGIBLE PLAN PARTICIPANTS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) ALEX ZUREK........................................................................ TRUSTEE	1.00 .......................40.00	X	0	158,540	29,049
(2) GENO ALESSANDRINI........................................................................ SECRETARY	1.00 .......................40.00	X	0	158,383	29,049
(3) MICHAEL AARON........................................................................ TRUSTEE	1.00 .......................40.00	X	0	132,863	0
(4) JOSEPH GALLINO........................................................................ TRUSTEE	1.00 .......................40.00	X	0	94,572	29,247
(5) ROBERT MALCOLM........................................................................ TRUSTEE	1.00 .......................40.00	X	0	87,384	26,072
(6) DAN HUSTED........................................................................ TRUSTEE	1.00 .......................40.00	X	0	75,661	27,028
(7) WA HENDRICK JR........................................................................ CHAIRMAN	1.00 .......................40.00	X	0	0	0
(8) MICHAEL NYSTROM........................................................................ TRUSTEE	1.00 .......................40.00	X	0	0	0
(9) JOEL CHRISTENSEN........................................................................ TRUSTEE	1.00 .......................40.00	X	0	0	0
(10) DAN EMMENECKER........................................................................ TRUSTEE	1.00 .......................40.00	X	0	0	0
(11) SCOTT FISHER........................................................................ TRUSTEE	1.00 .......................0.00	X	0	0	0
(12) GARY BEMJAMIN........................................................................ TRUSTEE	1.00 .......................40.00	X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	707,403	140,445

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......
			Business Code
2a	EMPLOYER CONTRIBUTIONS		230000	42,219,821	42,219,821
b	PARTICIPANT SELF-PAYMENTS		900099	7,054,446	7,054,446
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			49,274,267
3	Investment income (including dividends, interest, and other similar amounts).......			1,449,035			1,449,035
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	42,824,424
b	Less: cost or other basis and sales expenses	41,501,127
c	Gain or (loss)	1,323,297
d	Net gain or (loss)..........			1,323,297	1,323,297
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	MEDICARE SUBSIDY PART D		900099	338,365	338,365
b	LIQUIDATED DAMAGES		900099	11,013	11,013
c	OTHER		900099	903	903
d	All other revenue ....
e	Total. Add lines 11a–11d ......			350,281
12	Total revenue. See Instructions......			52,396,880	50,947,845		1,449,035

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members	43,159,883
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......	3,330,683
b	Legal .........	138,243
c	Accounting ...........	22,700
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	178,493
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	477,977
12	Advertising and promotion ....
13	Office expenses .......	15,200
14	Information technology ......	4,800
15	Royalties ..
16	Occupancy ...........
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	21,726
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....
23	Insurance ..............	22,762
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	LABORERS' NAT'L SAFETY	152,235
b	PRINTING AND MISC.	78,435
c	SUMMARY ANNUAL REPORT	33,754
d	NOTICES TO PARTICIPANTS	20,618
e	All other expenses	25,417
25	Total functional expenses. Add lines 1 through 24e	47,682,926	0	0	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).


			(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............		3,169,177	1	3,679,121
2	Savings and temporary cash investments .........		3,540,390	2	2,308,887
3	Pledges and grants receivable, net ...........			3
4	Accounts receivable, net .............		5,752,351	4	6,753,916
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				6
7	Notes and loans receivable, net .............			7
8	Inventories for sale or use ..............			8
9	Prepaid expenses and deferred charges ..........		1,787,338	9	1,716,968
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation .....	10b		10c
11	Investments—publicly traded securities ..........		59,596,181	11	64,112,811
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 .....			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........			15
16	Total assets. Add lines 1 through 15 (must equal line 34)......		73,845,437	16	78,571,703
17	Accounts payable and accrued expenses .........		876,907	17	1,265,760
18	Grants payable .................			18
19	Deferred revenue ................			19
20	Tax-exempt bond liabilities .............			20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			22
23	Secured mortgages and notes payable to unrelated third parties ..			23
24	Unsecured notes and loans payable to unrelated third parties ....			24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................		16,993,000	25	18,258,000
26	Total liabilities. Add lines 17 through 25.........		17,869,907	26	19,523,760
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			27
28	Temporarily restricted net assets ...........			28
29	Permanently restricted net assets ...........			29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........			30
31	Paid-in or capital surplus, or land, building or equipment fund .....			31
32	Retained earnings, endowment, accumulated income, or other funds		55,975,530	32	59,047,943
33	Total net assets or fund balances ...........		55,975,530	33	59,047,943
34	Total liabilities and net assets/fund balances ........		73,845,437	34	78,571,703