2017-07-19T16:44:54-05:00 2016-09-30 362152389 BANSLEY AND KIENER LLP 8745 W HIGGINS RD STE 200 CHICAGO IL 606312704 990 2015-10-01 362857218 LOCAL 25 SEIU WELFARE FUND LOCA 3122338800 111 EAST WACKER DRIVE 17TH FLOOR CHICAGO IL 60601 THOMAS BALANOFF CHAIRMAN 3122338800 2017-07-19 1 DANIELLE M TYLER P01433924 3122632700 2015 2021-01-29 14:40:06Z THOMAS BALANOFF 111 EAST WACKER DRIVE 17TH FLOOR CHICAGO IL 60601 854984991 0 X SEIU25.ORG X 1974 IL HEALTH CARE COVERAGE FOR PARTICIPANTS 6 0 20 0 0 0 0 0 118611409 122600555 403690 553195 560329 594649 119575428 123748399 0 0 108353923 109629451 1157198 1251744 0 0 0 1414940 1146141 110926061 112027336 8649367 11721063 48472581 58705326 12228690 10731942 36243891 47973384 TO PROVIDE HEALTH BENEFITS (HOSPITAL, SURGICAL, MAJOR MEDICAL AND DISABILITY) TO ELIGIBLE MEMBERS. 0 0 TO PROVIDE HEALTH BENEFITS (HOSPITAL, SURGICAL, MAJOR MEDICAL AND DISABILITY) TO ELIGIBLE MEMBERS. 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 139 0 1 20 1 0 0 0 0 0 0 X 6 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 1 1 0 0 X JAMES MCARDLE 3122338800 111 EAST WACKER DR 17TH FLOOR CHICAGO IL 60601 THOMAS BALANOFF TRUSTEE 2.00 40.00 X 0 218914 53291 STANLEY J GAYNOR TRUSTEE 2.00 0.00 X 0 0 0 LAURA GARZA TRUSTEE 2.00 40.00 X 0 135140 36459 ROBERT S GRAF TRUSTEE 2.00 0.00 X 0 0 0 DEAN L JOHNSON TRUSTEE 2.00 0.00 X 0 0 0 KENNETH E MUNZ TRUSTEE 2.00 40.00 X 0 100200 29219 JAMES MCARDLE FUND MANAGER 40.00 0.00 X 208000 0 49348 208000 454254 168317 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 PPO ADMIN FEES 2111553 ASHER GITTLER GREENFIELD & D'ALBA LTD 200 W JACKSON SUITE 1900 CHICAGO IL 60606 LEGAL SERVICES 116329 BANSLEY AND KIENER LLP 8745 W HIGGINS SUITE 200 CHICAGO IL 60631 ACCOUNTING AND AUDIT 113163 BENEFITS MANAGEMENT GROUP 1520 KENSIGTON SUITE 200 OAK BROOK IL 60523 CLAIMS SOFTWARE 103876 4 PARTICIPATING EMPLOYERS 900099 122021033 122021033 LIQUIDATED DAMAGES 900099 335040 335040 COBRA CONTRIBUTIONS 900099 238366 238366 MISCELLANEOUS INCOME 900099 6116 6116 122600555 511226 511226 619149 24500 594649 594649 594649 731254061 731212092 41969 41969 41969 123748399 122600555 0 1147844 109629451 142559 812749 219492 10367 66577 131083 94020 95251 166218 172545 161284 167972 29415 9503 9743 50316 PATIENT CENTERED OUTCOM 58791 112027336 32872 42880 10678423 11390768 53486 43232 4171386 3998103 127903 173283 36781252 46797626 798645 257537 48472581 58705326 384253 128844 22735 11844437 10580363 12228690 10731942 X 0 0 0 0 36243891 47973384 36243891 47973384 48472581 58705326 11721063 8430 0 X X 0 1 X 1 0 60669 60669 3931932 3904485 27447 178785 93618 85167 173283 CLAIMS INCURRED BUT NOT REPORTED 7141000 CLAIMS PAYABLE 2777000 ACCUMULATED ELIGIBILITY CREDITS 407000 BANK OVERDRAFT 255363 10580363 X 123661578 8430 8430 123653148 95251 95251 123748399 113277085 0 113277085 95251 -1345000 -1249749 112027336 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN ADMINISTRATOR TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY FOR ANY UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN PLAN'S BENEFIT OBLIGATIONS -1,345,000. X 0 0 0 THOMAS BALANOFF TRUSTEE 0 212162 0 0 0 6752 0 42432 0 10859 0 272205 0 0 LAURA GARZA TRUSTEE 0 128000 0 0 0 7140 0 25600 0 10859 0 171599 0 0 JAMES MCARDLE FUND MANAGER 208000 0 0 0 0 0 49348 0 0 0 257348 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WHICH IS PREPARED BY THE AUDITOR IS REVIEWED BY THE FUND MANAGER PRIOR TO FILING WITH THE IRS AND IS THEN SIGNED BY A MEMBER OF THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES IS PRESENTED WITH A FINAL COPY OF FORM 990 THAT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12 UNDER THE CONFLICT OF INTEREST POLICY, EMPLOYEES AND TRUSTEES ARE REQUIRED TO REPORT CONFLICTS OF INTEREST BEFORE ANY TRANSACTION IS CONSUMMATED. IT IS THE RESPONSIBILITY OF THE EMPLOYEES AND TRUSTEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES TO THE TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES, ALL OF WHOM ARE NOT COMPENSATED BY THE ORGANIZATION, DETERMINE AND APPROVE THE SALARY OF THE FUND MANAGER. THE FUND MANAGER'S SALARY AND BENEFITS ARE SHARED WITH THE LOCAL 25 SEIU AND PARTICIPATING EMLOYERS' PENSION TRUST. THE FUND MANAGER'S TOTAL COMPENSATION, LISTED ON PAGE 7 AND ON SCHEDULE J, IS ALLOCATED BETWEEN THE ORGANIZATION AND THE LOCAL 25 SEIU AND PARTICIPATING EMPLOYERS' PENSION TRUST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORMS 990 AND 5500 AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR INTERNAL POLICIES AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES SELECT THE INDEPENDENT AUDITORS. THE OVERSIGHT OF THE AUDIT IS PERFORMED BY THE FUND MANAGER. 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ALL CONTRIBUTING EMPLOYERS OF THE ORGANIZATION ARE LISTED IN PART IV OF SCHEDULE R.