INSTRUCTIONS

Each month you will receive a new EMPLOYER REPORTING STATEMENT (STATEMENT) showing the Employees reported for the previous month. Please complete this STATEMENT for the current month.

A.   If an Employee is not active, you must indicate the STATUS CODE (se list on reverse side) and DATE he/she became inactive in the column provided so proper COBRA notifications may be sent and records updated.
NOTE: An employee will NOT be deleted until you indicate on the statement that he is terminated.

B.   Add all active Employees that do not appear on the STATEMENT. Fill in the full name and Social Security Number. Also include a completed Checkoff Authorization Dependent Record with this STATEMENT for all new Employees.

C.   Make you checks payable as indicated – and mail them directly along with is Report to the designated address. All payments are due by the 10th of the month, and are considered “Delinquent” after that date. Failure to make the required contributions by the 20th of the month in which they are due will result in a 10% assessment of liquidated damages for Health & Welfare and Pension Contributions, and a 1.5% per month assessment of liquidated damages for delinquent Union dues and initiation fees.

D.   If you have any questions, please call (312) 738-0822.

1.   EMPLOYEE UNION DUES: A Union Dues payment of $27.00 shall be deducted from each Employee’s paycheck prior to the 10th day of the month. Any Employee who has worked at least one day in a month shall pay full dues for that month. In the event of termination, a full month’s dues shall be deducted. If the Employee is not activated until after the 10th of the month, a payroll deduction for a full month’s dues will be made on the Employee’s first payroll after being activated, and then remitted to the Union in addition to the following month’s dues.

2.   INITIATION FEES: The Initiation Fee is $100.00 and is to be deducted in two installments. The first installment of $50.00 plus Union Dues is to be deducted on the first payroll following completion of the Employee’s Probationary Period.

    EXAMPLES:   (Assumes probationary period is 30 days. If not, modify these examples to the probationary period contained in your Union Contract).

An Employee who completes his probationary period on or before the 10th of the month, the employees Union Dues and Initiation Fees will be remitted as follows:

HIRED	PROBATION ENDS	DUES & INITIATION FEES PAID IN AUGUST	DUES & INITIATION FEES PAID IN SEPT.
July 3	August 3	$27.00 Dues, $50.00 Initiation Fee (Total of $77.00 remitted)	$27.00 Dues, $50.00 Initiation Fee (Total of $77.00 remitted)

An Employee who completes his probationary period after the 20th of the month, the employees Union Dues and Initiation Fees will be remitted as follows:

HIRED	PROBATION ENDS	DUES & INITIATION FEES PAID IN AUGUST	DUES & INITIATION FEES PAID IN SEPT.
July 12	August 12	$54.00 Dues ($27 for August and $27 for Sept.) Initiation Fee $50.00 Initiation Fee (Total of $104.00 remitted)	$27.00 Dues, $50.00 Initiation Fee (Total of $77.00 remitted)

3.   HEALTH & WELFARE (H&W): If your Union Contract provides for a contribution to be made to the Health and Welfare Fund, the amount of the contribution is set forth in the Health and Welfare Article of the Union Contract and will be indicated in the column headed Welfare for those Employees who have met the contract’s H&W Article waiting period and for whom contributions are now due.

   NEW EMPLOYEES: Add the correct contribution in the column headed Welfare for those Employees who have met the contract’s H&W Article waiting period and for whom contributions are now due.

   If an employee contribution is due under the H&W language in the Union Contract, the payroll deduction method is optional as long as the full month’s contribution indicated on the STATEMENT is remitted. No payroll deductions are made if the contract requires the Employer to pay the entire costs of the Contribution monthly.

   FMLA: To report an Employee who has been approved for a leave of absence under FMLA, in addition to indicating the proper, STATUS CODE, you MUST submit, on Company letterhead:

• The beginning date of the FMLA Leave
• The reason
• The date the Employee is expected to return to work

If the Employee does not report back to work on the date expected, you must notify the Fund, in writing, so the proper COBRA notification can be sent.

4.   H&W Contributions are due for any employee who worked at least 8 hours in the month. If an Employee completes the H&W waiting period, or is reinstated prior to the 10th of the month, a remittance should be made on the employee’s behalf for that month. If an Employee completes the H&W waiting period, or is reinstated after the 10th of the month, the remittance is still due for that month, but should be made in addition to the remittance for the following month, and recorded on the EMPLOYER REPORTING STATEMENT.

5.   Pension: If you Union Contract provides for a contribution to be made to the Midwest Pension Plan, the amount of the contribution is set forth in the Pension Article of the Union Contract and will be indicated in the column headed “PENSION” on the STATEMENT.

   Pension Contributions are based upon the hours worked in the prior month. When a pension contribution is made for an employee, the hours for which he was compensated in the PRIOR MONTH must be reported as required by FEDERAL LAW on the STATEMENT in the column headed “PENSION HOUR”.

    EXAMPLES:   The Pension contributions that appears on the August STATEMENT are August contributions and are based on July hours of compensation and those July PENSION HOURS must be reported on the STATEMENT along with the contribution.

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