2017-08-28T12:29:41-05:00 2017-02-28 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BLVD STE 103 SCHERERVILLE IN 46375 990 2016-03-01 350940329 INDIANA BRICKLAYERS WELFARE FUND LOCAL 6 INDI 2197693376 7985 MARSHALL STREET MERRILLVILLE IN 46410 ROBERT PUZA FUND MANAGER 2197693376 2017-08-28 1 TIMOTHY LAKIS P00841931 2198361065 12.197.118.215 2017-08-28 12:28:10 CD P 5123AF178EF941FB4CAC23697FDA0C54B4043F85 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z ROBERT PUZA 7985 MARSHALL STREET MERRILLVILLE IN 46410 7831813 0 X N/A X 1954 IN TO PROVIDE HEALTH AND WELFARE BENEFITS AND LIFE INSURANCE COVERAGE FOR PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 12 11 5 0 0 0 0 0 3730414 3518907 163234 247846 0 0 3893648 3766753 0 0 3189021 3587839 158771 143213 0 0 0 178277 192318 3526069 3923370 367579 -156617 8750615 8917470 197397 72339 8553218 8845131 HEALTH BENEFIT FUND. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS AND LIFE INSURANCE COVERAGE FOR PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 4 0 1 5 1 0 0 0 0 0 0 0 0 X 12 11 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 IN X ROBERT PUZA 2197693376 7985 MARSHALL STREET MERRILLVILLE IN 46410 WILLIAM SOLIVAIS TRUSTEE - CHAIRMAN 1.00 1.00 X 0 0 0 JEREMY RIVAS TRUSTEE - SECRETARY 1.00 40.00 X 0 85308 62535 FRED COLVIN TRUSTEE 1.00 1.00 X 0 0 0 TODD ADAMS TRUSTEE 1.00 1.00 X 0 0 0 ANTHONY ARENS TRUSTEE 1.00 1.00 X 0 0 0 RICK KWIATKOWSKI TRUSTEE - PAST 1.00 1.00 X 0 0 0 JEFFREY COLVIN TRUSTEE 1.00 1.00 X 0 0 0 GERALD BROWN TRUSTEE 1.00 1.00 X 0 0 0 CHRIS DOOLIN TRUSTEE 1.00 1.00 X 0 0 0 ROBERT GREEN TRUSTEE 1.00 1.00 X 0 0 0 JEFFREY CAVINDER TRUSTEE 1.00 40.00 X 0 78724 42489 ROBERT ZEMAITIS TRUSTEE 1.00 1.00 X 0 0 0 PATRICK CLARK TRUSTEE - NEW 1.00 1.00 X 0 0 0 ROBERT PUZA FUND MANAGER - NEW 20.00 20.00 X 0 68467 41831 MARY VANGEL FUND MANAGER - PRIOR 20.00 20.00 X 0 16231 8000 0 248730 154855 0 0 0 0 ANTHEM 220 VIRGINIA AVE INDIANAPOLIS IN 46204 PPO NETWORK PROVIDER 144595 1 EMPLOYER CONTRIBUTIONS 900099 3152494 3152494 PARTICIPANT/RETIREE CONTRIBUTIONS 900099 366413 366413 3518907 227998 227998 4084908 4065060 19848 19848 19848 3766753 3518907 0 247846 3587839 55182 39822 25244 16587 6378 37271 33945 7956 40032 11973 18979 7029 7057 2625 10903 FEES MANDATED BY ACA 14548 3923370 4998 156748 396630 206244 290211 342963 13693 16794 8894 10526 7900 8048250 8189922 8750615 8917470 76894 59770 16395 10895 104108 1674 197397 72339 X 0 0 0 0 8553218 8845131 8553218 8845131 8750615 8917470 -156617 448530 0 X 0 1 X 1 0 16794 8894 7900 7900 DUE TO RELATED PENSION FUND 1674 1674 X 4207327 448530 448530 3758797 7956 7956 3766753 3915414 0 3915414 7956 7956 3923370 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. FORM 990, PART VI, SECTION A, LINE 2 FRED COLVIN (TRUSTEE) AND JEFFREY COLVIN (TRUSTEE) ARE BROTHERS. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO ENTIRE THE BOARD OF TRUSTEES FOR ITS REVIEW AND APPROVAL BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE PLAN HAS A CONFLICT OF INTEREST POLICY TO HELP ENSURE THAT ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST ARE DISCLOSSED AND ADDRESSED ON A TIMELY BASIS. IT IS THE DUTY OF THE FUND TRUSTEES AND EMPLOYEES TO IDENTIFY ACTUAL OR POTENTIAL CONFLICTS. IN CONNECTION WITH AN ACTUAL OR POTENTIAL CONFLICT THE PARTY-IN-INTEREST (OR ANY INTERESTED PARTY) WILL IMMEDIATELY DISCLOSE TO THE BOARD OF TRUSTEES THE EXISTENCE OF SUCH CONFLICT WITH DETAILED AND SPECIFIC FACTS. UPON DISCLOSURE, THE BOARD OF TRUSTEES WILL MEET FOR DISCUSSION AND A LEGAL OPINION IS SOUGHT WHETHER THERE IS, IN FACT, A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES DETERMINES THE FUND MANAGER'S SALARY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. FORM 990, PAGE 1, LINE 5 AND PAGE 10 LINE 7 THIS ENTITY SHARES EMPLOYEES WITH BRICKLAYERS UNION LOCAL NO. 6 OF INDIANA PENSION FUND. THE PAYROLL TAX FILINGS AND FORMS W-2 FOR THESE WAGES ARE FILED BY THE PENSION FUND. THE WELFARE FUND'S SHARE OF SALARY EXPENSE FOR THESE EMPLOYEES APPEAR ON PAGE 10. THE NUMBER OF PARTICIPANTS REPORTED ON W-3 FOR PART V QUESTION 2A REPRESENTS THE NUMBER OF PARTICIPANTS WHO RECEIVED THRID PARTY SICK PAY DURING THE YEAR. BRICKLAYERS UNION LOCAL NO6 OF INDIANA PENSION FUND 7985 MARSHALL STREET MERRILLVILLE IN 46410 516113680 PROVIDE RETIREMENT BENEFITS TO MEMBERS OR THEIR BENEFICIARIES IN 401(A) 0 BAC LOCAL 4 INKY 2041 N BROADWAY ANDERSON IN 46012 351938121 LABOR UNION IN 501(C)(5) 0 BAC LOCAL 4 INKY APPRENTICE AND TRAINING PROGRAM CONTRIBUTING EMPLOYER 0 ACCURATE MASONRY & RESTORATION CONTRIBUTING EMPLOYER N/A 0 0 MCLAUGHLIN MASONRY CONTRIBUTING EMPLOYER N/A 0 0 ACMS GROUP INC CONTRIBUTING EMPLOYER 0 ACTION CAULKING & SEALANT CONTRIBUTING EMPLOYER 0 ADAMS MASONRY INC CONTRIBUTING EMPLOYER 0 ALBERT INSTALLATIONS CONTRIBUTING EMPLOYER 0 ALGOZINE MASONRY RESTORATION CONTRIBUTING EMPLOYER 0 AMEX NOOTER LLC CONTRIBUTING EMPLOYER 0 ARCELORMITTAL USA INC CONTRIBUTING EMPLOYER 0 ART MOSAIC & TILE CO INC CONTRIBUTING EMPLOYER 0 ATLAS BUILDING SERVICES CONTRIBUTING EMPLOYER 0 BELDON INTERIORS INC CONTRIBUTING EMPLOYER 0 BERGLUND CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 BISCO REFRACTORIES INC CONTRIBUTING EMPLOYER 0 BLAKLEY CORPORATION CONTRIBUTING EMPLOYER 0 BMI REFRACTORY SERVICES INC CONTRIBUTING EMPLOYER 0 C & S MASONRY RESTORATION LLC CONTRIBUTING EMPLOYER 0 CALUMET MASONRY INC CONTRIBUTING EMPLOYER 0 COLVIN MASONRY CO CONTRIBUTING EMPLOYER 0 CUSTOM MASONRY RESTORATION INC CONTRIBUTING EMPLOYER 0 DON SCHARER MASONRY INC CONTRIBUTING EMPLOYER 0 F & J MASONRY CLEANING LLC CONTRIBUTING EMPLOYER 0 FABCON INC CONTRIBUTING EMPLOYER 0 FIVE STAR FLOORING CONTRIBUTING EMPLOYER 0 FOSBEL INC CONTRIBUTING EMPLOYER 0 GARIUP CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 GLASROCK PRODUCTS INC CONTRIBUTING EMPLOYER 0 GLASS DESIGN INC CONTRIBUTING EMPLOYER 0 GM SLOAN MOSAIC & TILE CO CONTRIBUTING EMPLOYER 0 GOUGH INC CONTRIBUTING EMPLOYER 0 GRAYCOR INDUSTRIAL CONSTRUCTORS INC CONTRIBUTING EMPLOYER 0 GROVE MASONRY MAINTENANCE CONTRIBUTING EMPLOYER 0 HARBISON-WALKER REFRACTORIES CO CONTRIBUTING EMPLOYER 0 HEIMBROCK INC CONTRIBUTING EMPLOYER 0 HESS CAULKING AND RESTORATION CONTRIBUTING EMPLOYER 0 HOLSTROM MASONRY CONST CONTRIBUTING EMPLOYER 0 HOT CREWS INC CONTRIBUTING EMPLOYER 0 INTERIOR FINISHES INC CONTRIBUTING EMPLOYER 0 INTERNATIONAL CHIMNEY CORPORATION CONTRIBUTING EMPLOYER 0 INTERNATIONAL MASONRY INC CONTRIBUTING EMPLOYER 0 J SQUARED MASONRY LLC CONTRIBUTING EMPLOYER 0 J T THORPE & SON INC CONTRIBUTING EMPLOYER 0 JOHN CARETTI & COMPANY CONTRIBUTING EMPLOYER 0 JP LARSEN INC CONTRIBUTING EMPLOYER 0 KAUFMANN-GALLAGHER WATERPROOFING INC CONTRIBUTING EMPLOYER 0 KNOTTS MASONRY & CONSTRUCTION CONTRIBUTING EMPLOYER 0 KORELLIS ROOFING INC CONTRIBUTING EMPLOYER 0 KWIATKOWSKI MASONRY INC CONTRIBUTING EMPLOYER 0 L & S MASONRY INC CONTRIBUTING EMPLOYER 0 LARSON-DANIELSON CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 LOWERY TILE CONTRIBUTING EMPLOYER 0 LOZICH MASONRY CONTRIBUTING EMPLOYER 0 MASTER TILE INC CONTRIBUTING EMPLOYER 0 MATRIX NORTH AMERICAN CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MID-AMERICAN GUNITE INC CONTRIBUTING EMPLOYER 0 MIDWEST TILE & INTERIORS CONTRIBUTING EMPLOYER 0 MORRISON CONSTRUCTION COMPANY INC CONTRIBUTING EMPLOYER 0 NATIONAL MACHINERY & CONVEYOR INC CONTRIBUTING EMPLOYER 0 NIES EGGERT WATERPROOFING COMPANY INC CONTRIBUTING EMPLOYER 0 ONEX CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 PAULS CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 PREMIER CAULKING INC CONTRIBUTING EMPLOYER 0 PYRO INDUSTRIAL SERVICES INC CONTRIBUTING EMPLOYER 0 QUALITY CUSTOM INTALL CONTRIBUTING EMPLOYER 0 R D MASONRY CONTRIBUTING EMPLOYER 0 R V BUILDERS CONTRIBUTING EMPLOYER 0 RAM CONSTRUCTION SERVICES OF MICHIGAN INC CONTRIBUTING EMPLOYER 0 RAMCORP INC CONTRIBUTING EMPLOYER 0 REFTECH INTERNATIONAL REFRACTORIES CONTRIBUTING EMPLOYER 0 REGION FLOORING INC CONTRIBUTING EMPLOYER 0 RESCH TILE INC CONTRIBUTING EMPLOYER 0 RESCO PRODUCTS INC CONTRIBUTING EMPLOYER 0 RESTOREWORKS CONTRIBUTING EMPLOYER 0 SCHAD BOILER SETTING CO CONTRIBUTING EMPLOYER 0 SLATILE ROOFING & RESTORATION INC CONTRIBUTING EMPLOYER 0 SONGER STEEL SERVICES INC CONTRIBUTING EMPLOYER 0 STONE & WEBSTER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 T&K MASONRY INC CONTRIBUTING EMPLOYER 0 TONN & BLANK INC CONTRIBUTING EMPLOYER 0 TRE SERVICES CONTRIBUTING EMPLOYER 0 TRIUMPH RESTORATION INC CONTRIBUTING EMPLOYER 0 WAUBONSEE DEVELOPMENT CONTRIBUTING EMPLOYER 0 WESTERN REFRACTORY CONSTRUCTION CONTRIBUTING EMPLOYER 0 ZIOLKOWSKI CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 1