2017-07-20T13:50:29-05:00 2016-12-31 271235638 MOUNTJOY CHILTON MEDLEY LLP 462 S FOURTH ST SUITE 2600 LOUISVILLE KY 402023445 990 2016-01-01 237017526 KENTUCKY LABORERS DISTRICT COUNCIL HEALTH & WELFARE FUND KENT 5028398166 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 JAMES BLEVINS CHAIRMAN 5028398166 2017-07-17 1 REBECCA L PHILLIPS CPA P00024055 5027491900 128.136.148.166 2017-07-17 10:32:43 ED P 67686B56B41F7CCF39B57D3FBA82A7CCB21CF855 DDBE644EB59A07040B5A4823541C87990C964E24 2016 2021-01-29 14:40:06Z MARK ISAACS 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 34598301 0 X N/A X 1967 KY EMPLOYEE BENEFIT PLAN PROVIDING ACCIDENT, SICKNESS, VISION, DENTAL, DEATH AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS FOR ACTIVE PARTICIPANTS AND ACCIDENT, SICKNESS, VISION, DENTAL AND DEATH BENEFITS FOR RETIRED PARTICIPANTS. 8 8 11 9 0 0 0 0 24407864 23202114 441661 702191 68338 59280 24917863 23963585 0 0 21894869 23465415 906526 947287 0 0 0 1281519 1151672 24082914 25564374 834949 -1600789 31342881 30410044 365069 794074 30977812 29615970 EMPLOYEE BENEFIT PLAN PROVIDING ACCIDENT, SICKNESS, VISION, DENTAL, DEATH AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS FOR ACTIVE PARTICIPANTS AND ACCIDENT, SICKNESS, VISION, DENTAL AND DEATH BENEFITS FOR RETIRED PARTICIPANTS. 0 0 EMPLOYEE BENEFIT PLAN PROVIDING ACCIDENT, SICKNESS, VISION, DENTAL, DEATH AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS FOR ACTIVE PARTICIPANTS AND ACCIDENT, SICKNESS, VISION, DENTAL AND DEATH BENEFITS FOR RETIRED PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 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 1039 0 1 11 1 0 0 0 0 0 0 X 8 8 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X D CROUCH FUND ADMINISTRATORS GRIFFIETH FUND ASSISTANT 5028398166 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 X JAMES BLEVINS CHAIRMAN 1.00 X X 0 0 0 DOUG HACKER SECRETARY/TREASURER 1.00 X X 0 0 0 PERRY BLADES TRUSTEE 1.00 X 0 0 0 MITCHELL ONEY TRUSTEE 1.00 X 0 0 0 MARK ISAACS TRUSTEE 1.00 X 0 0 0 DONALD TRAVIS TRUSTEE 1.00 X 0 0 0 JEFF STORY TRUSTEE 1.00 X 0 0 0 ANTHONY WICKLINE TRUSTEE 1.00 X 0 0 0 LARRY HENDERSON ALTERNATE TRUSTEE (ALTERNATE) 1.00 X 0 0 0 0 0 0 0 0 0 0 CIGNA PO BOX 644546 PITTSBURGH PA 152644546 REPRICING OF CLAIMS, PRE-CERTIFICATION 457307 ZELLIS (FORMERLY PHX) 2 CROSSROADS DRIVE BEDMNISTER NJ 07921 REPRICING OF NON-PPO CLAIMS 167372 BENESYS 700 TOWER DR SUITE 300 TROY MI 48098 CONSULTING AND ELIGIBILITY AND CLAIMS PR 109400 3 EMPLOYER CONTRIBUTIONS 900099 21633878 21633878 EMPLOYEE CONTRIBUTIONS 900099 1568236 1568236 23202114 452735 452735 10884172 10634716 249456 249456 249456 CONTRIBUTION RECORDS F 900099 59280 59280 59280 23963585 23261394 0 702191 23465415 611594 170477 127295 37921 31075 31822 56229 643147 167600 108377 40996 19 15532 9515 14087 INTERNATIONAL FOUNDATIO 26260 PCORI TAX 7013 25564374 1421571 500836 1933953 2521823 18054 18054 104637 82340 31811 22297 27937492 27347034 31342881 30410044 365069 794074 365069 794074 X 30977812 29615970 0 0 0 0 30977812 29615970 31342881 30410044 -1600789 238947 0 X X 0 1 X 1 0 28610 28609 1 76027 53731 22296 22297 X 24202532 238947 238947 23963585 0 23963585 25564374 0 25564374 0 25564374 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE ("IRC"), AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER DATED MAY 14, 1969 FROM THE INTERNAL REVENUE SERVICE ("IRS"), AND THE PLAN ADMINISTRATOR AND THE PLAN'S TAX COUNSEL BELIEVE THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC. U.S. GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2016 AND 2015, THERE ARE NO UNCERTAIN TAX 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. FORM 990, PART VI, SECTION A, LINE 4 PLAN DOCUMENT WAS RESTATED JANUARY 1, 2016 TO INCLUDE COVERAGE FOR WEIGHT REDUCTION SURGERY AND ANY COMPLICATIONS ARISING THEREFROM FOR THOSE COVERED SURGERIES PERFORMED JANUARY 1, 2015 AND AFTER, PROVIDED SPECIFIC MEDICAL CRITERIA ARE MET AND DOCUMENTATION OF SAID MEDICAL CRITERIA ARE SUBMITTED TO THE FUND IN ACCORDANCE WITH PLAN REQUIREMENTS. IN ADDITION, COVERAGE AT 100% UP TO A $500 MAXIMUM [NOT SUBJECT TO MAJOR MEDICAL DEDUCTIBLE] FOR PROGRAM FEES RELATED TO SUCH WEIGHT REDUCTION SURGERY. PLAN DOCUMENT WAS RESTATED APRIL 1, 2016 TO INCLUDE COVERAGE FOR TREATMENT OF MENTAL/NERVOUS DISORDERS AND SUBSTANCE ABUSE SHALL BE PAYABLE AS ANY OTHER ILLNESS FOR CLAIMS INCURRED APRIL 1, 2017 AND AFTER. SERVICES-PROVIDED BY A LICENSED CHEMICAL DEPENDENCY UNIT (CDU), SHALL BE PAYABLE PROVIDED SUCH SERVICES AR FOR THE TREATEMENT OF SUBSTANCE ABUSE AND HAVE BEEN PRESCRIBED BY A PHYSICIAN. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE FUND AUDITOR. IT IS REVIEWED BY THE FUND ATTORNEY, FUND CONSULTANT AND FUND ADMINISTRATOR PRIOR TO PRESENTATION TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN REVIEW THE FORM 990 BEFORE APPROVAL AND SIGNING. AFTER APPROVAL AND EXECUTION BY BOARD OF TRUSTEES, THE FORM 990 IS FILED. (IN THIS CASE, IT IS E-FILED BY THE FUND AUDITOR) FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE OR EMPLOYEE OF THE FUND HAS THE DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST. EACH TRUSTEE OR EMPLOYEE MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE TRUSTEES DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE BOARD OF TRUSTEES WILL DISCUSS AND VOTE TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST IS DETERMINED TO EXIST, THE CHAIRPERSON OF THE BOARD OF TRUSTEES SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. THE BOARD OF TRUSTEES SHALL THEN DETERMINE WHETHER THE FUND CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OF TRUSTEES SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE FUND'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING WAGE INCREASES FOR FUND EMPLOYEES, THE TRUSTEES REVIEW THE CURRENT AND PROJECTED FINANCIAL STATUS OF THE FUND, INCLUDING CURRENT AND PROJECTED ADMINISTRATIVE COSTS, AND TAKE INTO CONSIDERATION THE WAGES FOR SIMILAR POSITIONS IN OTHER TAFT-HARTLEY TRUST FUNDS, PROJECTED COST OF LIVING TRENDS, AND EMPLOYEES' WORK HISTORIES AND JOB PERFORMANCES. THE TRUSTEES HAVE ALSO IMPLEMENTED A POLICY WHEREIN THE ADMINISTRATOR WILL PERFORM ANNUAL JOB PERFORMANCE REVIEWS FOR EACH FUND EMPLOYEE. THE FUND TRUSTEES DO NOT RECEIVE COMPENSATION OF ANY KIND. THERE IS NO CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL OF THIS FUND. FORM 990, PART VI, SECTION C, LINE 19 THEY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. THE FUND'S ADMINISTRATOR AND ASSISTANT ADMINISTRATOR CONTINUE TO OVERSEE THE AUDIT PROCESS OF ITS FINANCIAL STATEMENTS. HOWEVER, THE FULL BOARD OF TRUSTEES FOR THE FUND ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE BOARD OF TRUSTEES REVIEWS AND APPROVES ALL MONTHLY FINANCIAL STATEMENTS AT THEIR QUARTERLY MEETINGS AND REVIEWS THE ANNUAL FINANCIAL REPORT AT A QUARTERLY MEETING. 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