2015-01-11T10:42:16-06:00 2014-05-31 470900880 CALIBRE CPA GROUP PLLC 566 W LAKE ST STE 300 CHICAGO IL 606611414 990 2013-06-01 366219639 FOX VALLEY LABORERS HEALTH & WELFARE FND FOXV 8477420900 2371 BOWES ROAD No 500 ELGIN IL 601235523 DAN BREJC Trustee/Secretary 8477420900 2015-01-05 1 ANDREW HEIN P00499757 3126550037 2013 2016-02-25 16:41:14Z X MIKE SHALES 2371 BOWES ROAD No 500 ELGIN IL 601235523 47099993 0 X N/A X 1968 IL TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 6 6 43 0 0 0 0 0 25243963 27803015 2003979 2831720 284716 295670 27532658 30930405 0 0 19795277 27192597 790666 802471 0 0 0 1564291 1758867 22150234 29753935 5382424 1176470 61944759 68249473 9011114 12464785 52933645 55784688 TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. THERE WERE 1,467 ELIGIBLE PARTICIPANTS AT MAY 31, 2014. 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 1 710 0 1 43 1 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 1 1 0 0 X PAT SHALES 8477420900 2371 BOWES ROAD SUITE 500 ELGIN IL 601235523 DAN BREJC Secretary 3.00 40.00 X 0 128027 74629 JOHN BRYAN JR TRUSTEE 3.00 X 0 0 0 MIKE SHALES Chairman 3.00 X 0 0 0 VERN BAUMAN Trustee 3.00 40.00 X 0 118071 87822 JEFF FROST Trustee 3.00 50.00 X 0 135508 95726 AL OROSZ Trustee 3.00 X 0 0 0 PATRICIA M SHALES ADMINISTRATOR 40.00 X 123220 0 36460 123220 381606 294637 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO ACCESS FEES 650351 SEI INVESTMENT ONE FREEDOM DRIVE OAKS PA 19456 INV MGMNT/CONSULTING 139558 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DRIVE MIAMI FL 331565629 PLAN CONSULTING 112928 3 EMPLOYER CONTRIBUTIONS 900099 26553072 26553072 MEMBER CONTRIBUTIONS 900099 1156126 1156126 MEDICARE D SUBSIDIES 900099 93817 93817 27803015 1373813 1373813 17627495 16169588 1457907 1457907 1457907 REIMB SAL & RELATED EXPENSES FROM 900099 295670 295670 295670 30930405 28098685 0 2831720 27192597 451309 166874 135142 49146 108038 57535 353619 1011845 141436 34479 1394 7368 15955 27198 29753935 -41660 -90585 19932 44954 2595463 3088427 45314 80613 300586 261739 49776 38847 59199814 64968429 76120 118788 61944759 68249473 62114 69785 8949000 12395000 9011114 12464785 X 0 0 0 0 52933645 55784688 52933645 55784688 61944759 68249473 1176470 1674573 0 X X 0 1 X 1 0 22481 6744 15737 278105 254995 23110 38847 EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY 9660000 EST LIAB FUTR CLAIMS INCURRED BUT UNPAID 2690000 DEPOSITS HELD 45000 12395000 X 31861872 1674573 -353619 1320954 30540918 389487 389487 30930405 25589829 -93817 -93817 25683646 4070289 4070289 29753935 Part X, Line 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGMENT TO EVALUATE TAX POSISTIONS 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 TAXING AUTHORITIES. AS OF MAY 31, 2014, THERE WERE NO UNCERTAIN TAX POSISTIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION IF 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. AT MAY 31, 2014, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2011. Part XI, Line 2d - Other Adjustments: INVESTMENT MANAGEMENT EXPENSE -353,619. Part XI, Line 4b - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED 93,817. REIMBURSED FV PENSION SALARY EXPENSE 295,670. Part XII, Line 2d - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED -93,817. Part XII, Line 4b - Other Adjustments: REIMBURSED FV PENSION SALARY EXPENSE 295,670. INVESTMENT MANAGEMENT EXPENSE 353,619. CHANGE IN PLAN BENEFIT OBLIGATION 3,421,000. X 0 0 0 DAN BREJC Secretary 0 124796 0 0 0 3231 0 48119 0 26510 0 202656 0 0 VERN BAUMAN Trustee 0 113516 0 0 0 4555 0 54595 0 33227 0 205893 0 0 JEFF FROST Trustee 0 134605 0 0 0 903 0 35093 0 60633 0 231234 0 0 PATRICIA M SHALES ADMINISTRATOR 110877 0 3500 0 8843 0 20091 0 16369 0 159680 0 0 0 Form 990, Part VI, Section A, line 8b THE ORGANIZATION DOES NOT HAVE COMMITTEES TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11 THE TRUSTEES OF THE FOX VALLEY AND VICINITY LABORERS HEALTH AND WELFARE FUND HAVE AUTHORIZED THE CHAIRMAN OF THE FUND TO REVIEW THE FORM 990 PRIOR TO FILING. A COPY OF THE FILED RETURN IS MADE AVAILABLE TO ALL TRUSTEES TO REVIEW SUBSEQUENT TO FILING. Form 990, Part VI, Section B, line 12c THE ACTIONS OF THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND ERISA. BOTH ESTABLISH STANDARDS OF CONDUCT FOR PLAN FIDUCIARIES. IN ADDITION, THE ADMINISTRATOR OF THE PLAN HAS SIGNED AN EMPLOYMENT CONTRACT WITH THE FUND WHICH ALSO ESTABLISHES STANDARDS OF CONDUCT. THE TRUSTEES AND ADMINISTRATOR ARE RQUIRED TO DISCLOUSE ANY POSSIBLE CONFLICTS OF INTREST TO THE ENTIRE BOARD. Form 990, Part VI, Section B, line 15a THE TRUSTEES OF THE FUND ANNUALLY REVIEW THE PERFORMANCE OF THE FUND'S TOP MANAGEMENT OFFICIAL (ADMINISTRATOR) AND APPROVE ANY COMPENSATION ADJUSTMENTS. Form 990, Part VI, Section C, line 19 A SUMMARY ANNUAL REPORT IS DISTRIBUTED TO ALL PARTICIPANTS ANNUALLY. PARTICIPANTS ARE ABLE TO REQUEST THE AUDITOR'S REPORT AND OTHER FINANCIAL INFORMATION FROM THE FUND OFFICE AND/OR THE US DEPARTMENT OF LABOR. Form 990, Part XII, line 2c: No change in process from prior year. FOX VALLEY & VICINITY LABORERS PENSION 2371 BOWES Rd NO 500 ELGIN IL 601235523 366147409 PENSION FUND IL 401(a) 0 LABORERS LOCAL #149 2418 W INDIAN TRAIL AURORA IL 60506 361264214 LABOR UNION IL 501(c)(5) 0 LABORERS LOCAL #1035 110 N STATE PO BOX 211 MARENGO IL 601520211 362063944 LABOR UNION IL 501(c)(5) 0 LABORERS LOCAL #582 2400 BIG TIMBER ROAD BLDG B ELGIN IL 601247812 361265047 LABOR UNION IL 501(c)(5) 0 FOX VALLEY ASSOCIATED GENERAL CONTRACTORS 2020 DEAN ST NO I ST CHARLES IL 60174 362244731 CONTRACTORS ASSOCIATION IL 501(c)(6) 0 ILLINOIS ROAD AND TRANSPORTATION BUILDERS ASSOCIATION 500 PARK BLVD 1250 ITASCA IL 60143 361257695 CONTRACTORS ASSOCIATION IL 501(c)(6) 0 BOSLY CONSTRUCTION LLC BUILDERS CONCRETE SERVICES LLC CONSOLIDATED CONSTR SERV LLC COOLING LAND CONCEPTS LLC CORRECTIVE ASP MATERIALS LLC CROUCH-SERANKO MASONRY LLC DOUGAL BUILDING MAINT LLC GFS CONSTRUCTION LLC IHC CONSTRUCTION CO LLC JACK COFFEY LLC JIM GEORGE AND SONS LLC KENDALL EXC & SEPTIC LLC KRESMERY MARC 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