2016-07-15T12:44:59-05:00 2015-12-31 271235638 MOUNTJOY CHILTON MEDLEY LLP 462 S FOURTH ST SUITE 2600 LOUISVILLE KY 402023445 990 2015-01-01 237017526 KENTUCKY LABORERS DISTRICT COUNCIL HEALTH & WELFARE FUND KENT 5028398166 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 JAMES BLEVINS CHAIRMAN 5028398166 2016-07-07 1 REBECCA L PHILLIPS CPA P00024055 5027491900 2015 2016-12-15 16:53:06Z JAMES BLEVINS 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 37679487 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 10 9 0 0 0 0 23848439 24407864 365038 441661 28761 68338 24242238 24917863 0 0 18634506 21894869 852933 906526 0 0 0 1083950 1281519 20571389 24082914 3670849 834949 30755128 31342881 479680 365069 30275448 30977812 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 1412 0 1 10 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 DANA CROUCH KENTUCKY LABORERS DISTRICT COUNCIL HEALTH & WELFARE FUND 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 PAUL REYNOLDS TRUSTEE (TERM ENDED 4/15/15) 1.00 X 0 0 0 DONALD TRAVIS TRUSTEE 1.00 X 0 0 0 JEFF STORY TRUSTEE (TERM BEGAN 4/15/15) 1.00 X 0 0 0 ANTHONY WICKLINE TRUSTEE (TERM BEGAN 1/14/15) 1.00 X 0 0 0 LARRY HENDERSON ALTERNATE TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 CIGNA PO BOX 644546 PITTSBURGH PA 15264 PPO AND CASE MANAGEMENT 454205 PREMIER HEALTHCARE EXCHANGE 2 CROSSROADS DRIVE BEDMINSTER NJ 07921 OUT OF NETWORK CLAIMS DISCOUNT 134895 BENESYS 700 TOWER DR SUITE 300 TROY MI 48098 SOFTWARE PROVIDER AND CONSULTANT 110700 3 EMPLOYER CONTRIBUTIONS 900099 22770229 22770229 EMPLOYEE CONTRIBUTIONS 900099 1637635 1637635 24407864 406677 406677 12796608 12761348 276 35260 -276 34984 34984 CONTRIBUTION RECORDS F 900099 68338 68338 68338 24917863 24476202 0 441661 21894869 542587 165880 121800 76259 28439 34503 59574 803744 145410 109399 40549 8517 9677 13172 INTERNATIONAL FOUNDATIO 21396 PCORI TAX 7139 24082914 1184844 1421571 2172834 1933953 15798 18054 104636 72825 19757 31811 27361895 27937492 30755128 31342881 479680 365069 479680 365069 X 30275448 30977812 0 0 0 0 30275448 30977812 30755128 31342881 834949 -132585 0 X X 0 1 X 1 0 28610 26736 1874 76026 46089 29937 31811 X 24882879 0 24882879 34984 34984 24917863 24180515 97601 97601 24082914 0 24082914 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 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 OPPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON ASSET DISPOSAL -276. GAIN ON SALE OF SECURITIES 35,260. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON ASSET DISPOSAL 276. GAIN ON SALE OF SECURITIES -35,260. UNREALIZED GAINS 132,585. FORM 990, PART VI, SECTION A, LINE 4 IN JANUARY 2015, THE PLAN WAS AMENDED FOR THE FOLLOWING CHANGES EFFECTIVE JANUARY 1, 2015: - IN ACCORDANCE WITH APPLICABLE PLAN PROCEDURES, A PARTICIPANT INCLUDING HIS DEPENDENTS, MAY ELECT TO OPT-OUT OF DENTAL AND VISION BENEFIT COVERAGE BY PROVIDING THE PLAN PRIOR WRITTEN NOTICE OF SUCH ELECTION. TERMINATION OF COVERAGE WILL TAKE EFFECT THE 1ST DAY OF THE MONTH FOLLOWING WRITTEN NOTICE TO TERMINATE COVERAGE. - IN ACCORDANCE WITH APPLICABLE PLAN PROCEDURES, A PARTICIPANT INCLUDING HIS DEPENDENTS, MAY ELECT TO RESUME DENTAL AND VISION BENEFIT COVERAGE BY PROVIDING THE PLAN PRIOR WRITTEN NOTICE OF SUCH ELECTION. RESUMPTION OF COVERAGE WILL TAKE EFFECT THE 1ST DAY OF THE MONTH FOLLOWING WRITTEN NOTICE TO TERMINATE COVERAGE. - COVERAGE FOR CHARGES FOR HEARING AIDS SHALL BE $3,000 PER EAR PER PERSON ONCE EVERY FIVE CALENDAR YEARS. COVERAGE WILL BE FOR HEARING AIDS ONLY AND WILL NOT COVER REPAIRS, SUPPLIES OR MAINTENANCE. - COVERAGE WILL INCLUDE CHARGES FOR WEIGHT REDUCTION SURGERY AND ANY COMPLICATIONS ARISING THEREFROM FOR THOSE COVERED SURGERIES PERFORMED. - THE ANNUAL OUT-OF-POCKET MAXIMUM FOR MAJOR MEDICAL COVERAGE SHALL TOTAL $5,000 PER PERSON AND $10,000 PER FAMILY. THIS MAXIMUM SHALL INCLUDE THE DEDUCTIBLE, COINSURANCE AND $10 OUT-OF-NETWORK OFFICE VISIT PENALTY FOR MAJOR MEDICAL COVERAGE. - THE ANNUAL OUT-OF-POCKET MAXIMUM FOR PRESCRIPTION COVERAGE SHALL TOTAL $1,600 PER PERSON AND $3,200 PER FAMILY. THIS MAXIMUM WILL INCLUDE PRESCRIPTION COPAYS. - VISION BENEFITS SHALL BE INCREASED FROM $400 PER PERSON ONCE EVERY 24 MONTHS TO $500 PER PERSON EVERY 24 MONTHS. FORM 990, PART VI, SECTION B, LINE 11 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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