2018-06-15T10:13:20-05:00 2017-07-31 320043599 LEGACY PROFESSIONALS LLP 4 WESTBROOK CORPORATE CTR 700 WESTCHESTER IL 60154 990 2016-08-01 596152618 PLUMBERS & PIPEFITTERS LOCAL UNION NO 803 HEALTH AND WELFARE FUND PLUM 9045380100 8657 BAYPINE ROAD BUILDING 5 NO 200 JACKSONVILLE FL 32256 WILLIE C GREGORY TRUSTEE 9045380100 2018-06-15 1 GREG WALLENBECKER P01451145 3123680500 2016 2022-09-23 18:48:47Z WILLIE C GREGORY 8657 BAYPINE ROAD BUILDING 5 NO 200 JACKSONVILLE FL 32256 4139730 0 X N/A X 1965 FL PROVIDE HEALTH BENEFITS 6 6 0 0 0 0 0 0 4260847 4036435 46846 103295 67770 0 4375463 4139730 0 0 2390115 3332914 0 0 0 0 0 644722 199045 3034837 3531959 1340626 607771 4609363 5303093 43670 18483 4565693 5284610 PROVIDE HEALTH BENEFITS 0 0 THE FUND PROVIDES HEALTH, VISION, AND DEATH BENEFITS TO ELIGIBLE PARTICIPANTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 197 0 1 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 0 0 0 X NATIONAL EMPLOYEE BENEFIT ADMINISTR 9045380100 8657 BAYPINE ROAD BUILDING 5 SUITE JACKSONVILLE FL 32256 WILLIE C GREGORY TRUSTEE 1.00 40.00 X 0 68179 0 BRANDON THOMAS TRUSTEE 1.00 40.00 X 0 16990 21413 GARY MONSON TRUSTEE 1.00 X 0 0 0 BERNARD HORNE TRUSTEE 1.00 X 0 0 0 PAUL V JONES TRUSTEE 1.00 X 0 0 0 TIM MILES TRUSTEE 1.00 X 0 0 0 0 85169 21413 0 0 0 0 OPTUM RX PO BOX 27275 NEW YORK NY 100877275 PRESCRIPTION BENEFIT PROVIDER 386563 FLORIDA HOSPITAL MEDICAL CTR PO BOX 862304 ORLANDO FL 328862304 HEALTHCARE PROVIDER 376074 ORLANDO HEALTH INC PO BOX 62000 STOP 9936 ORLANDO FL 329819936 HEALTHCARE PROVIDER 298269 SHANDS HOSPITAL ACUTE PO BOX 100005 ATLANTA GA 303480005 HEALTHCARE PROVIDER 124280 CIGNA HEALTH CARE 1111 MARKET STREET CHATTANOOGA TN 37402 HEALTHCARE PROVIDER 116145 6 EMPLOYER CONTRIBUTIONS 900099 3707698 3707698 PARTICIPANT & RETIREE 900099 210803 210803 STOP-LOSS RECOVERY 900099 117934 117934 4036435 103295 103295 4139730 4036435 0 103295 3332914 64641 8507 15600 4122 68194 17332 6380 5564 FEES MANDATED BY ACA 8705 3531959 1569518 875992 189873 160124 563417 465803 28211 2675 2258344 3798499 4609363 5303093 34346 18483 9324 0 43670 18483 X 0 0 0 0 4565693 5284610 4565693 5284610 4609363 5303093 607771 111146 0 X 0 1 X 1 0 0 X 4246754 111146 111146 4135608 4122 4122 4139730 3527837 0 3527837 4122 4122 3531959 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 3 WHILE THE TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED CONTROL OVER DAY-TO-DAY MANAGEMENT DUTIES TO NATIONAL EMPLOYEE BENEFITS ADMINISTRATORS, INC., A THIRD PARTY ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 8B THE FUND DOES NOT HAVE A SEGREGATED COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED, THROUGHLY REVIEWED AND APPROVED BY THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE FUND IS REQUIRED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT TO DISCLOSE ANY CONFLICTS OF INTEREST. THE TRUSTEES MONITOR AND ENFORCE THE FUND'S COMPLIANCE WITH ERISA WITH ASSISTANCE FROM THE FUND'S PROFESSIONALS. FORM 990, PART VI, SECTION C, LINE 19 THE FUND MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. PLUMBERS & PIPEFITTERS LOCAL 803 PENSION FUND 8657 BAYPINE ROAD BUILDING 5 STE 20 JACKSONVILLE FL 32256 596228172 PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS FL 401(A) N/A 0 PLUMBERS & PIPEFITTERS LOCAL 803 JATC FUND 8657 BAYPINE ROAD BUILDING 5 STE 20 JACKSONVILLE FL 32256 596227992 TO TRAIN AND EDUCATE APPRENTICES AS PLUMBERS & PIPEFITTERS FL 501(C)(5) N/A 0 UNITED ASSOCIATION OF PLUMBERS & PIPEFITTERS LOCAL 803 CONTRIBUTING EMPLOYER 0 ACKERMAN PLUMBING CONTRIBUTING EMPLOYER 0 ASSURANCE AIRE LLC CONTRIBUTING EMPLOYER 0 CARRIER CORPORATION CONTRIBUTING EMPLOYER 0 CELSIUS CONTRACTORS INC CONTRIBUTING EMPLOYER 0 CORRECT CONSTRUCTION CONTRIBUTING EMPLOYER 0 FLORIDA MECHANICAL CONTRIBUTING EMPLOYER 0 GRAY & ASSOCIATES CONTRIBUTING EMPLOYER 0 HILL YORK SERVICE CORP CONTRIBUTING EMPLOYER 0 HONEYWELL INTL INC CONTRIBUTING EMPLOYER 0 IRVINE MECHANICAL INC CONTRIBUTING EMPLOYER 0 JAMES B DONAGHEY INC CONTRIBUTING EMPLOYER 0 JOHNSON CONTROLS INC CONTRIBUTING EMPLOYER 0 JPI MECHANICAL SERVICES CONTRIBUTING EMPLOYER 0 JUSTICE AIR CONDITIONING CONTRIBUTING EMPLOYER 0 KINETICS SYSTEMS INC CONTRIBUTING EMPLOYER 0 MECHANICAL SERVICES INC CONTRIBUTING EMPLOYER 0 PAGE PIPING INC CONTRIBUTING EMPLOYER 0 PERSEVERE MECHANICAL CONTRIBUTING EMPLOYER 0 SAUER GROUP INC CONTRIBUTING EMPLOYER 0 SHAW MECHANICAL SERVICE CONTRIBUTING EMPLOYER 0 SIEMENS BUILDING TECH I CONTRIBUTING EMPLOYER 0 THERMETRICS CORP CONTRIBUTING EMPLOYER 0 WALT DISNEY WORLD CONTRIBUTING EMPLOYER 0 W SOULE & COFORMERLY OR CONTRIBUTING EMPLOYER 0 WW GAY MECHANICAL CONTR CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PLUMBERS & PIPEFITTERS LOCAL 803 PENSION FUND S 158110 COST