2014-06-10T11:15:32-05:00 2013-10-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2012-11-01 362265130 CONSTRUCTION INDUSTRY WELFARE FUND OF ROCKFORD ILLINOIS CONS 8153974267 1322 EAST STATE STREET ROCKFORD IL 61104 DAVE FLEURY 8153974267 2014-06-10 1 TIMOTHY CIBULKA P00841100 3123680500 2012 2015-11-30 17:44:51Z DAVE FLEURY 1322 EAST STATE STREET ROCKFORD IL 61104 21600672 0 X N/A X 1954 IL TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS. 7 3 32 0 49748 -6659 0 0 15539198 15453811 360317 257554 74623 73748 15974138 15785113 0 0 16804646 15427841 108987 112070 0 0 0 792184 759709 17705817 16299620 -1731679 -514507 15272275 14650776 669452 622651 14602823 14028125 TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS. 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, PRESCRIPTION DRUGS, LIFE, AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 1 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 X 6 0 1 32 1 1 1 0 0 0 0 0 0 0 X 7 3 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X SHELLI MCPEEK - ADMINISTRATOR 8153974267 1322 EAST STATE STREET ROCKFORD IL 61104 DAVE FLEURY 3.00 40.00 X 0 185625 36874 SAM GIARDONO 3.00 40.00 X 7262 0 0 DAN JANSEN 3.00 40.00 X 0 85986 30864 ART STURMS 3.00 40.00 X 0 100542 40328 LYNN ULRICH 3.00 40.00 X 0 0 0 TODD STEFFEN 3.00 40.00 X 0 0 0 GLEN TURPOFF 3.00 6.00 X 0 42000 0 SHELLI MCPEEK 40.00 0.00 X 52541 0 16240 59803 414153 124306 0 0 1 0 GROUP ADMINISTRATORS LTD 915 NATIONAL PARKWAY SUITE F SCHAUMBURG IL 60173 THIRD PARTY ADMINISTRATOR 392544 BLUE CROSS BLUE SHIELD OF IL 300 E RANDOLPH STREET CHICAGO IL 60601 PPO PROVIDER 354134 2 CONTRACTOR CONTRIBUTIONS 900099 14356208 14356208 PARTICIPANT CONTRIBUTIONS 900099 944032 944032 PRESCRIPTION REBATES 900099 153387 153387 STOP-LOSS PROCEEDS 900099 184 184 15453811 316235 316235 5756878 5815559 -58681 -58681 -58681 PROCESSING FEES 900099 49748 49748 SHARED SERVICE FEES 900099 24000 24000 73748 15785113 15453811 49748 281554 15427841 52541 50170 9359 385596 135575 85296 61321 37844 15287 9753 3710 25327 16299620 2502809 2607816 3487596 3609506 2235894 2298816 67686 8505 18648 8102 130251 92434 15927 37817 6943715 6080214 15272275 14650776 10121 4624 326196 659331 291831 669452 622651 X 0 0 0 0 14602823 14028125 14602823 14028125 15272275 14650776 -514507 -60191 0 X 0 1 X 1 0 0 1 X 10977 732 10245 119274 91702 27572 37817 EMPLOYER RECIPROCAL CONTRIBUTIONS 279806 DUE TO AFFILIATED ORGANIZATIONS 12025 291831 X 15724922 -60191 -60191 15785113 0 15785113 16299620 0 16299620 0 16299620 PART IV, LINE 2B: THE PLAN SERVES AS A CONDUIT TO COLLECT REMITTANCES ON BEHALF OF AFFILIATED BENEFIT FUNDS AND ORGANIZATIONS. SUCH REMITTANCES ARE INITIALLY RECEIVED THROUGH A LOCKBOX ARRANGEMENT AND TRANSFERRED INTO A SEGREGATED CHECKING ACCOUNT HELD BY THE PLAN UNTIL DISBURSEMENT TO THE AFFILIATED ENTITY IS MADE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 0 0 0 DAVE FLEURY 0 185625 0 0 0 0 0 20800 0 16074 0 222499 0 0 FORM 990, PART V, LINE 2A THE NUMBER OF EMPLOYEES REPORTED ON LINE 2A INCLUDE PARTICIPANTS RECEIVING LOSS OF TIME BENEFITS. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND PLAN ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARD'S REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICT OF INTEREST POLICY - THE FUND IS AN EMPLOYEE WELFARE BENEFIT PLAN GOVERNED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). UNDER ERISA, IT IS THE CONTINUING RESPONSIBILITY OF EACH MEMBER OF THE BOARD OF TRUSTEES TO REVIEW TRANSACTIONS FOR POTENTIAL CONFLICTS OF INTEREST, IMMEDIATELY DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, AND TAKE APPROPRIATE ACTION UPON DISCOVERY OF SUCH CONFLICT. TO ASSIST THE TRUSTEES IN IDENTIFYING ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, THE FUND DISTRIBUTES TO EACH TRUSTEE AN ANNUAL QUESTIONNAIRE REQUESTING INFORMATION REGARDING INTERESTS THAT COULD GIVE RISE TO A CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. 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