401k Plan data: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND plan

OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 401k Plan overview

Plan Name	OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND
Plan identification number	501

OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL 12 has sponsored the creation of one or more 401k plans.

Company Name: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL 12

Employer identification number (EIN): 237307587

NAIC Classification: 238300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-09-01 JOSEPH WEST
501 2011-09-01 JOSEPH WEST
501 2010-09-01 JOSEPH WEST
501 2009-09-01 JAMES E BODTKE
501 2009-09-01 JAMES E BODTKE

Plan id#	Filing Submission Date	Name of Administrator
501	2012-09-01	JOSEPH WEST
501	2011-09-01	JOSEPH WEST
501	2010-09-01	JOSEPH WEST
501	2009-09-01	JAMES E BODTKE
501	2009-09-01	JAMES E BODTKE

Plan Statistics for OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND

401k plan membership statisitcs for OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND

Measure Date Value
2012: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2012 401k membership
Total participants, beginning-of-year 2012-09-01 127
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 108
Number of retired or separated participants receiving benefits 2012-09-01 19
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 127
Number of employers contributing to the scheme 2012-09-01 62
2011: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2011 401k membership
Total participants, beginning-of-year 2011-09-01 111
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 103
Number of retired or separated participants receiving benefits 2011-09-01 24
Number of other retired or separated participants entitled to future benefits 2011-09-01 0
Total of all active and inactive participants 2011-09-01 127
Number of employers contributing to the scheme 2011-09-01 53
2010: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2010 401k membership
Total participants, beginning-of-year 2010-09-01 145
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 88
Number of retired or separated participants receiving benefits 2010-09-01 23
Total of all active and inactive participants 2010-09-01 111
Number of employers contributing to the scheme 2010-09-01 28
2009: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2009 401k membership
Total participants, beginning-of-year 2009-09-01 133
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 133
Number of retired or separated participants receiving benefits 2009-09-01 12
Total of all active and inactive participants 2009-09-01 145
Number of employers contributing to the scheme 2009-09-01 28

Measure	Date	Value
2012: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2012 401k membership
Total participants, beginning-of-year	2012-09-01	127
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	108
Number of retired or separated participants receiving benefits	2012-09-01	19
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	127
Number of employers contributing to the scheme	2012-09-01	62
2011: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2011 401k membership
Total participants, beginning-of-year	2011-09-01	111
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	103
Number of retired or separated participants receiving benefits	2011-09-01	24
Number of other retired or separated participants entitled to future benefits	2011-09-01	0
Total of all active and inactive participants	2011-09-01	127
Number of employers contributing to the scheme	2011-09-01	53
2010: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2010 401k membership
Total participants, beginning-of-year	2010-09-01	145
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	88
Number of retired or separated participants receiving benefits	2010-09-01	23
Total of all active and inactive participants	2010-09-01	111
Number of employers contributing to the scheme	2010-09-01	28
2009: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2009 401k membership
Total participants, beginning-of-year	2009-09-01	133
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	133
Number of retired or separated participants receiving benefits	2009-09-01	12
Total of all active and inactive participants	2009-09-01	145
Number of employers contributing to the scheme	2009-09-01	28

Financial Data on OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND

Measure	Date	Value
2013 : OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-08-31	$90,590
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-08-31	$0
Total income from all sources (including contributions)	2013-08-31	$2,413,911
Total loss/gain on sale of assets	2013-08-31	$0
Total of all expenses incurred	2013-08-31	$2,156,258
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-08-31	$1,919,062
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-08-31	$1,438,172
Value of total assets at end of year	2013-08-31	$1,823,774
Value of total assets at beginning of year	2013-08-31	$1,475,531
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-08-31	$237,196
Total interest from all sources	2013-08-31	$450
Total dividends received (eg from common stock, registered investment company shares)	2013-08-31	$318
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-08-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-08-31	$318
Administrative expenses professional fees incurred	2013-08-31	$60,335
Was this plan covered by a fidelity bond	2013-08-31	Yes
Value of fidelity bond cover	2013-08-31	$200,000
If this is an individual account plan, was there a blackout period	2013-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-08-31	No
Contributions received from participants	2013-08-31	$80,216
Assets. Other investments not covered elsewhere at end of year	2013-08-31	$4,685
Assets. Other investments not covered elsewhere at beginning of year	2013-08-31	$4,870
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-08-31	$326,193
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-08-31	$18,744
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-08-31	$90,590
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-08-31	$0
Other income not declared elsewhere	2013-08-31	$975,875
Administrative expenses (other) incurred	2013-08-31	$67,875
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-08-31	No
Value of net income/loss	2013-08-31	$257,653
Value of net assets at end of year (total assets less liabilities)	2013-08-31	$1,733,184
Value of net assets at beginning of year (total assets less liabilities)	2013-08-31	$1,475,531
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-08-31	No
Were any leases to which the plan was party in default or uncollectible	2013-08-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-08-31	$18,368
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-08-31	$18,833
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-08-31	$1,265,321
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-08-31	$1,066,080
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-08-31	$1,066,080
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-08-31	$450
Expenses. Payments to insurance carriers foe the provision of benefits	2013-08-31	$339,827
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-08-31	$-904
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-08-31	No
Was there a failure to transmit to the plan any participant contributions	2013-08-31	No
Has the plan failed to provide any benefit when due under the plan	2013-08-31	No
Contributions received in cash from employer	2013-08-31	$1,357,956
Employer contributions (assets) at end of year	2013-08-31	$209,207
Employer contributions (assets) at beginning of year	2013-08-31	$367,004
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-08-31	$1,579,235
Contract administrator fees	2013-08-31	$108,986
Did the plan have assets held for investment	2013-08-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-08-31	No
Opinion of an independent qualified public accountant for this plan	2013-08-31	Unqualified
Accountancy firm name	2013-08-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2013-08-31	410746749
2012 : OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-08-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-08-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-08-31	$0
Total income from all sources (including contributions)	2012-08-31	$1,685,729
Total loss/gain on sale of assets	2012-08-31	$0
Total of all expenses incurred	2012-08-31	$1,817,321
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-08-31	$1,713,331
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-08-31	$1,529,357
Value of total assets at end of year	2012-08-31	$1,475,531
Value of total assets at beginning of year	2012-08-31	$1,607,123
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-08-31	$103,990
Total interest from all sources	2012-08-31	$8,124
Total dividends received (eg from common stock, registered investment company shares)	2012-08-31	$3,205
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-08-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-08-31	$3,205
Administrative expenses professional fees incurred	2012-08-31	$58,601
Was this plan covered by a fidelity bond	2012-08-31	Yes
Value of fidelity bond cover	2012-08-31	$200,000
If this is an individual account plan, was there a blackout period	2012-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-08-31	No
Contributions received from participants	2012-08-31	$74,422
Assets. Other investments not covered elsewhere at end of year	2012-08-31	$4,870
Assets. Other investments not covered elsewhere at beginning of year	2012-08-31	$4,870
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-08-31	$18,744
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-08-31	$96,842
Other income not declared elsewhere	2012-08-31	$150,159
Administrative expenses (other) incurred	2012-08-31	$13,843
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-08-31	No
Value of net income/loss	2012-08-31	$-131,592
Value of net assets at end of year (total assets less liabilities)	2012-08-31	$1,475,531
Value of net assets at beginning of year (total assets less liabilities)	2012-08-31	$1,607,123
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-08-31	No
Were any leases to which the plan was party in default or uncollectible	2012-08-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-08-31	$18,833
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-08-31	$113,463
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-08-31	$1,066,080
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-08-31	$1,060,075
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-08-31	$1,060,075
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-08-31	$8,124
Expenses. Payments to insurance carriers foe the provision of benefits	2012-08-31	$339,382
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-08-31	$-5,116
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-08-31	Yes
Was there a failure to transmit to the plan any participant contributions	2012-08-31	No
Has the plan failed to provide any benefit when due under the plan	2012-08-31	No
Contributions received in cash from employer	2012-08-31	$1,454,935
Employer contributions (assets) at end of year	2012-08-31	$367,004
Employer contributions (assets) at beginning of year	2012-08-31	$331,873
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-08-31	$1,373,949
Contract administrator fees	2012-08-31	$31,546
Did the plan have assets held for investment	2012-08-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-08-31	No
Opinion of an independent qualified public accountant for this plan	2012-08-31	Unqualified
Accountancy firm name	2012-08-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2012-08-31	410746749
2011 : OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2011 401k financial data
Total income from all sources (including contributions)	2011-08-31	$1,458,702
Total of all expenses incurred	2011-08-31	$1,524,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-08-31	$1,408,804
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-08-31	$1,224,555
Value of total assets at end of year	2011-08-31	$1,607,123
Value of total assets at beginning of year	2011-08-31	$1,673,193
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-08-31	$115,968
Total interest from all sources	2011-08-31	$1,835
Total dividends received (eg from common stock, registered investment company shares)	2011-08-31	$9,231
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-08-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-08-31	$9,231
Administrative expenses professional fees incurred	2011-08-31	$55,725
Was this plan covered by a fidelity bond	2011-08-31	Yes
Value of fidelity bond cover	2011-08-31	$200,000
If this is an individual account plan, was there a blackout period	2011-08-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-08-31	No
Contributions received from participants	2011-08-31	$94,583
Assets. Other investments not covered elsewhere at end of year	2011-08-31	$4,870
Assets. Other investments not covered elsewhere at beginning of year	2011-08-31	$4,984
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-08-31	$96,842
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-08-31	$86
Other income not declared elsewhere	2011-08-31	$227,048
Administrative expenses (other) incurred	2011-08-31	$26,980
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-08-31	No
Value of net income/loss	2011-08-31	$-66,070
Value of net assets at end of year (total assets less liabilities)	2011-08-31	$1,607,123
Value of net assets at beginning of year (total assets less liabilities)	2011-08-31	$1,673,193
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-08-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-08-31	No
Were any leases to which the plan was party in default or uncollectible	2011-08-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-08-31	$113,463
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-08-31	$358,200
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-08-31	$1,060,075
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-08-31	$1,009,147
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-08-31	$1,009,147
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-08-31	$1,835
Expenses. Payments to insurance carriers foe the provision of benefits	2011-08-31	$276,442
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-08-31	$-3,967
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-08-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-08-31	No
Has the plan failed to provide any benefit when due under the plan	2011-08-31	No
Contributions received in cash from employer	2011-08-31	$1,129,972
Employer contributions (assets) at end of year	2011-08-31	$331,873
Employer contributions (assets) at beginning of year	2011-08-31	$300,776
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-08-31	$1,132,362
Contract administrator fees	2011-08-31	$33,263
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-08-31	No
Did the plan have assets held for investment	2011-08-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-08-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-08-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-08-31	No
Opinion of an independent qualified public accountant for this plan	2011-08-31	Unqualified
Accountancy firm name	2011-08-31	CLIFTONLARSENALLEN LLP
Accountancy firm EIN	2011-08-31	410746749

Form 5500 Responses for OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND

2012: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2012 form 5500 responses
2012-09-01	Type of plan entity	Multi-employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	Yes
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan funding arrangement – Trust	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement - Trust	Yes
2011: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2011 form 5500 responses
2011-09-01	Type of plan entity	Multi-employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	Yes
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan funding arrangement – Trust	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement - Trust	Yes
2010: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2010 form 5500 responses
2010-09-01	Type of plan entity	Multi-employer plan
2010-09-01	Submission has been amended	Yes
2010-09-01	Plan is a collectively bargained plan	Yes
2010-09-01	Plan funding arrangement – Insurance	Yes
2010-09-01	Plan funding arrangement – Trust	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement - Trust	Yes
2009: OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL NO 12 HEALTH AND WELFARE FUND 2009 form 5500 responses
2009-09-01	Type of plan entity	Multi-employer plan
2009-09-01	Submission has been amended	Yes
2009-09-01	This submission is the final filing	No
2009-09-01	Plan is a collectively bargained plan	Yes
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan funding arrangement – Trust	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement - Trust	Yes

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Company Name:	OPERATIVE PLASTERERS' AND CEMENT MASONS' LOCAL 12
Employer identification number (EIN):	237307587
NAIC Classification:	238300