2016-11-10T12:55:22-06:00 2016-02-29 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BLVD STE 103 SCHERERVILLE IN 46375 990 2015-03-01 350940329 INDIANA BRICKLAYERS WELFARE FUND LOCAL 6 INDI 2197693376 7985 MARSHALL STREET MERRILLVILLE IN 46410 ROBERT PUZA FUND MANAGER 2197693376 2016-11-10 1 TIMOTHY LAKIS P00841931 2198361065 2015 2017-02-10 21:41:12Z ROBERT PUZA 7985 MARSHALL STREET MERRILLVILLE IN 46410 14545096 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 3 0 0 0 0 0 4002930 3730414 155865 163234 0 0 4158795 3893648 0 0 3344481 3189021 142758 158771 0 0 0 189468 178277 3676707 3526069 482088 367579 8720191 8750615 234260 197397 8485931 8553218 TO PROVIDE HEALTH AND WELFARE BENEFITS AND LIFE INSURANCE COVERAGE FOR PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 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 0 0 1 3 1 0 0 0 0 0 0 0 0 0 0 X 12 11 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 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 80247 59161 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 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 69905 16362 ROBERT ZEMAITIS TRUSTEE 1.00 1.00 X 0 0 0 MARY VANGEL FUND MANAGER - PRIOR 20.00 20.00 X 0 78314 43766 ROBERT PUZA FUND MANAGER - NEW 20.00 20.00 X 0 6598 3500 0 235064 122789 0 0 0 0 ANTHEM 220 VIRGINIA AVE INDIANAPOLIS IN 46204 PPO NETWORK PROVIDER 150349 1 EMPLOYER CONTRIBUTIONS 900099 3420020 3420020 PARTICIPANT/RETIREE CONTRIBUTIONS 900099 310394 310394 3730414 208449 208449 10606233 10651448 -45215 -45215 -45215 3893648 3730414 0 163234 3189021 76412 36447 23855 14779 7278 36498 22740 9795 38976 11331 11285 7260 2504 2624 10808 FEES MANDATED BY ACA 24456 3526069 4359 4998 498963 396630 338156 290211 7244 0 16795 6269 13150 10526 7858319 8048250 8720191 8750615 145125 76894 0 16395 89135 104108 234260 197397 X 0 0 0 0 8485931 8553218 8485931 8553218 8720191 8750615 367579 -300292 0 X 0 1 X 1 0 16795 6269 10526 10526 DUE TO RELATED PENSION FUND 104108 104108 X 3583561 -300292 -300292 3883853 9795 9795 3893648 3516274 0 3516274 9795 9795 3526069 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 11 A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES FOR ITS REVIEW AND APPROVAL BEFORE IT IS FILED. 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 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 RETURN 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 APPEARS ON PAGE 10. THE NUMBER OF EMPLOYEES REPORTED ON W-3 FOR PART V QUESTION 2A REPRESENTS THE NUMBER OF INDIVIDUALS WHO RECEIVED THIRD 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 401(A) 0 BAC LOCAL 4 INKY 2041 N BROADWAY ANDERSON IN 46012 351938121 LABOR UNION 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 ABLE MASONRY DEVELOPMENT CO CONTRIBUTING EMPLOYER 0 ADAMS MASONRY INC CONTRIBUTING EMPLOYER 0 ARCELORMITTAL USA INC CONTRIBUTING EMPLOYER 0 ARCHITECTURAL SOUTHWEST STONE LLC CONTRIBUTING EMPLOYER 0 JM ARGENTA INC CONTRIBUTING EMPLOYER 0 ARMORMAX CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 ART MOSAIC & TILE CO INC CONTRIBUTING EMPLOYER 0 BMI REFRACTORY SERVICES INC CONTRIBUTING EMPLOYER 0 BELDON INTERIORS INC CONTRIBUTING EMPLOYER 0 BERGLUND CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 BISCO REFRACTORIES INC CONTRIBUTING EMPLOYER 0 BORNOR RESTORATION INC CONTRIBUTING EMPLOYER 0 C&S MASONRY RESTORATION LLC CONTRIBUTING EMPLOYER 0 CALUMET MASONRY CO CONTRIBUTING EMPLOYER 0 JOHN CARETTI & COMPANY CONTRIBUTING EMPLOYER 0 COLVIN MASONRY CO CONTRIBUTING EMPLOYER 0 CUSTOM MASONRY RESTORATION INC CONTRIBUTING EMPLOYER 0 ESCORZA TILE INC CONTRIBUTING EMPLOYER 0 F & J MASONRY CLEANING LLC CONTRIBUTING EMPLOYER 0 FIVE STAR FLOORING CONTRIBUTING EMPLOYER 0 FORSLAND JONES INC CONTRIBUTING EMPLOYER 0 FOSBEL INC CONTRIBUTING EMPLOYER 0 GARIUP CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 GARY COMMUNITY SCHOOL CONTRIBUTING EMPLOYER 0 GLASROCK PRODUCTS INC CONTRIBUTING EMPLOYER 0 GLASS DESIGN INC CONTRIBUTING EMPLOYER 0 GOUGH INC CONTRIBUTING EMPLOYER 0 GRAYCOR INDUSTRIAL CONSTRUCTORS INC CONTRIBUTING EMPLOYER 0 HAGERMAN CONSTRUCTION CORP CONTRIBUTING EMPLOYER 0 HARBISON-WALKER REFRACTORIES CO CONTRIBUTING EMPLOYER 0 HEIMBROCK REFRACTORY SERVICES CONTRIBUTING EMPLOYER 0 I W & G INC CONTRIBUTING EMPLOYER 0 INTERIOR FINISHES INC CONTRIBUTING EMPLOYER 0 INTERNATIONAL CHIMNEY CORPORATION CONTRIBUTING EMPLOYER 0 J SQUARED MASONRY INC CONTRIBUTING EMPLOYER 0 JW FLOORING LLC CONTRIBUTING EMPLOYER 0 KAUFMANN-GALLAGHER WATERPROOFING INC CONTRIBUTING EMPLOYER 0 KORELLIS ROOFING INC CONTRIBUTING EMPLOYER 0 KWIATKOWSKI MASONRY INC CONTRIBUTING EMPLOYER 0 LAKE SHORE FLOOR COVERING CORP CONTRIBUTING EMPLOYER 0 J P LARSEN INC CONTRIBUTING EMPLOYER 0 LARSON-DANIELSON CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 G LOLOS MASONRY CONTRIBUTING EMPLOYER 0 MVP ERECTORS LLC 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 RESTORATION INC CONTRIBUTING EMPLOYER 0 MIDWEST TILE & INTERIORS CONTRIBUTING EMPLOYER 0 MORRISON CONSTRUCTION COMPANY INC CONTRIBUTING EMPLOYER 0 MR DAVID'S FLOORING INTERNATIONAL LLC CONTRIBUTING EMPLOYER 0 ROSCO MYERS MASONRY CONTRIBUTING EMPLOYER 0 NATIONAL ACID-PROOFING INC CONTRIBUTING EMPLOYER 0 NATIONAL MACHINERY & CONVEYOR INC CONTRIBUTING EMPLOYER 0 NIES EGGERT WATERPROOFING COMPANY INC CONTRIBUTING EMPLOYER 0 PAUL'S CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 PLIBRICO COMPANY LLC CONTRIBUTING EMPLOYER 0 PREMIER CAULKING INC CONTRIBUTING EMPLOYER 0 PULLMAN POWER PRODUCTS CORPORATION CONTRIBUTING EMPLOYER 0 PYRO INDUSTRIAL SERVICES INC CONTRIBUTING EMPLOYER 0 RKV MASONRY INC CONTRIBUTING EMPLOYER 0 RV BUILDERS CONTRIBUTING EMPLOYER 0 RAM CONSTRUCTION SERVICES OF MICHIGAN INC CONTRIBUTING EMPLOYER 0 RAMCORP INC CONTRIBUTING EMPLOYER 0 RC CAST RESTORATION & CLEANING CONTRIBUTING EMPLOYER 0 REGION FLOORING INC CONTRIBUTING EMPLOYER 0 RESTOREWORKS CONTRIBUTING EMPLOYER 0 S AND D MASONRY INC CONTRIBUTING EMPLOYER 0 SSSI INC CONTRIBUTING EMPLOYER 0 SCHAD BOILER SETTING CO CONTRIBUTING EMPLOYER 0 DON SCHARER MASONRY INC CONTRIBUTING EMPLOYER 0 SHARED SYSTEMS TECHNOLOGY INC CONTRIBUTING EMPLOYER 0 SLATILE ROOFING & RESTORATION INC CONTRIBUTING EMPLOYER 0 GM SLOAN MOSAIC & TILE CO CONTRIBUTING EMPLOYER 0 STEWART SERVICES INC CONTRIBUTING EMPLOYER 0 STONE & WEBSTER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 T&K MASONRY INC CONTRIBUTING EMPLOYER 0 THOMPSON BROTHERS CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 J T THORPE & SON INC CONTRIBUTING EMPLOYER 0 TONN & BLANK INC CONTRIBUTING EMPLOYER 0 TRI MASONRY INC CONTRIBUTING EMPLOYER 0 TRIUMPH RESTORATION INC CONTRIBUTING EMPLOYER 0 UNLIMITED MASONRY & CONSTRUCTION INC 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 0