2023-03-28T08:46:54-05:00 2022-05-31 470900880 Calibre CPA Group PLLC 566 West Lake Street Chicago IL 60661 990 2021-06-01 361264190 NECA IBEW 176 HEALTH & WELFARE FUND NECA 8157292666 1100 N E FRONTAGE ROAD JOLIET IL 60431 ANDY RICO Trustee as of Filing Date 8157292666 2023-03-28 1 ANDY RICO 999009999 Howard Simon P00158008 3126550037 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z David Ruder 1100 N E FRONTAGE ROAD JOLIET IL 60431 59516669 0 X N/A X 1975 IL TO PROVIDE MEDICAL, DISABILITY, LIFE, AND AD&D BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 6 3 87 0 0 0 0 0 28906861 31415345 973027 822208 0 0 29879888 32237553 0 0 25682230 30260865 42322 60098 0 0 0 1687109 2003537 27411661 32324500 2468227 -86947 62865839 60369090 28209494 28477943 34656345 31891147 TO PROVIDE MEDICAL, DISABILITY, LIFE, AND AD&D BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 PAYMENTS OF MEDICAL, DENTAL, VISION, DISABILITY, LIFE, AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 6 0 1 87 1 0 0 0 0 0 0 0 0 X 6 3 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 X NICHOLE CASSEM 8157292666 1100 NE FRONTAGE ROAD JOLIET IL 60431 DAVID RUDER TRUSTEE 3.00 8.00 X 0 0 0 NICK OLSEN TRUSTEE 3.00 6.00 X 0 8973 6832 PAUL ROLIH TRUSTEE 3.00 8.00 X 0 0 0 MICHAEL CLEMMONS TRUSTEE 3.00 46.00 X 0 139165 84392 JEFF KEAST TRUSTEE 3.00 6.00 X 0 0 0 ANDREW MAGRUDER FORMER TRUSTEE 3.00 6.00 X 0 1240 1014 RYAN ALDRICH TRUSTEE 3.00 3.00 X 0 0 0 0 149378 92238 0 0 1 0 BLUE CROSSBLUE SHIELD 300 E RANDOLPH STREET CHICAGO IL 60601 CLAIMS PAYER/NETWORK 713726 ZENITH ADMINISTRATORS 18861 90TH AVENUE SUITE A MOKENA IL 60448 THIRD-PARTY ADMIN 450969 CERNER CORPORATION PO Box 959156 St Louis MO 63195 HEALTHCARE NETWORK 302492 ARNOLD & KADJAN 203 N LASALLE SUITE 1650 CHICAGO IL 60601 LEGAL SERVICES 126079 4 EMPLOYER CONTRIBUTIONS 900099 28828691 28828691 EMPLOYEE CONTRIBUTIONS 900099 2375262 2375262 RETIREE CONTRIBUTIONS 900099 185563 185563 COBRA SUBSIDY INCOME 900099 25829 25829 31415345 604367 604367 27496957 27279116 217841 217841 217841 32237553 31415345 0 822208 30260865 60098 532472 200796 57935 109350 1035049 44840 12132 10963 32324500 8206006 6435535 4247132 3926650 37360 301838 1381372 111163 0 1270209 38059974 36866923 12236497 11501139 78870 66796 62865839 60369090 4267404 4195843 23942090 24282100 28209494 28477943 X 0 0 0 0 34656345 31891147 34656345 31891147 62865839 60369090 -86947 -2678251 0 X X 0 1 X 1 0 1366038 95829 1270209 15334 15334 0 1270209 COMMON COLLECTIVE TRUSTS - NIS 11501139 F 11501139 CLAIMS INCURRED BUT NOT REPORTED 2316000 EXTENDED ELIGIBILITY 11521000 ACCUM PART MED SAV ACCOUNTS 10274100 Insurance premiums due 171000 24282100 X 29449952 -2678251 -2678251 32128203 109350 109350 32237553 31875140 -340010 -340010 32215150 109350 109350 32324500 Part X, Line 2: The trust established under the Plan to hold the Plan's assets is qualified pursuant to Section 501(c)(9) of the Internal Revenue Code as a tax-exempt organization. The Plan has obtained a favorable tax determination letter from the Internal Revenue Service, and the Plan Sponsor believes that the Plan, as amended, continues to qualify and to operate in accordance with applicable provisions of the Internal Revenue Code. Accounting principles generally accepted in the United States of America require plan management to evaluate tax positions taken by the Plan and recognize a tax liability (or asset) if the Plan has taken an uncertain position that more likely than not would not be sustained upon examination by the IRS. The Plan administrator has analyzed the tax positions taken by the Plan, and has concluded that as of May 31, 2022, there are no uncertain positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. At May 31, 2022, the Plan is no longer subject to income tax examinations for the years prior to the year ended May 31, 2019. Part XII, Line 2d - Other Adjustments: CHANGE IN BENEFIT OBLIGATIONS -340,010. 0 0 0 MICHAEL CLEMMONS TRUSTEE 0 138565 0 0 0 600 0 41246 0 43146 0 223557 0 0 Form 990, Part VI, Section A, line 3 Line 3 explanation - ZENITH ADMINISTRATORS IS THE THIRD PARTY ADMINISTRATOR HIRED TO ADMINISTER THE FUND'S DAY-TO-DAY OPERATIONS. Form 990, Part VI, Section B, line 11b THE TRUSTEES AUTHORIZE THE FUND'S THIRD-PARTY ADMINISTRATOR AND A DESIGNATED TRUSTEE TO REVIEW THE FORM 990 BEFORE IT IS FILED. Form 990, Part VI, Section B, line 12c THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND A WRITTEN POLICY AND HAVE A FIDUCIARY RESPONSIBILITY UNDER ERISA TO ADMINISTER THE PLAN IN THE BEST INTEREST OF THE MEMBERSHIP. THE U.S. DEPARTMENT OF LABOR REQUIRES ALL LABOR TRUSTEES TO REPORT ON FORM LM-30 POTENTIAL SITUATIONS WHERE THERE MAY BE CONFLICTS OF INTEREST. THIS INFORMATION IS OPEN TO THE PUBLIC. Form 990, Part VI, Section C, line 19 A SUMMARY ANNUAL REPORT IS DISTRIBUTED TO ALL PARTICIPANTS. PARTICIPANTS ARE ABLE TO REQUEST THE AUDITOR'S REPORT AND OTHER FINANCIAL INFORMATION FROM THE PLAN ADMINISTRATOR AND/OR THE U.S. DEPARTMENT OF LABOR. ALSO, FORM 5500 IS OPEN TO PUBLIC INSPECTION THROUGH THE U.S. DEPARTMENT OF LABOR. 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