2013-03-12T13:26:00-05:00 2012-04-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2011-05-01 262336180 SEIU HEALTHCARE IL HOME CARE & CHILD CARE FUND SEIU 7733859300 7026 W NORTH AVENUE CHICAGO IL 60707 TERRI HARKIN 7733859300 2013-03-12 1 JAMES J GIEMZIK P00741996 3123680500 2011 2016-02-25 16:41:14Z TERRI HARKIN 7026 W NORTH AVENUE CHICAGO IL 60707 279680235 0 X N/A X 2008 IL TO PROVIDE HEALTH BENEFITS 6 6 0 0 0 0 0 0 58530054 61138406 3250037 5810724 31141 5207 61811232 66954337 0 0 30830270 56623600 992291 1097738 0 0 0 956802 1126367 32779363 58847705 29031869 8106632 90462250 96345928 197245 242260 90265005 96103668 PROVIDE HEALTH BENEFITS. 0 0 TO PROVIDE HEALTH CARE, PRESCRIPTION DRUGS, VISION CARE, LIFE INSURANCE, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS FOR ELIGIBLE PARTICIPANTS. 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 0 1 3042 0 1 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 X MR ZACHARY NAUTH 7733859300 7026 W NORTH AVENUE CHICAGO IL 60707 X TERRI HARKIN 1.00 X 0 0 0 KEITH KELLEHER 1.00 X 0 0 0 MAGGIE LASLO 1.00 X 0 0 0 DARBY ANDERSON 1.00 X 0 0 0 RAYMOND HUGHES 1.00 X 0 0 0 RON FORD 1.00 X 0 0 0 0 0 0 0 0 0 0 UNION HEALTH SERVICES INC 1634 W POLK STREET CHICAGO IL 60612 HMO FEES 6365721 AEGIS ADMINISTRATIVE SERVICES 6970 W DIVERSEY AVENUE CHICAGO IL 60707 RX ADMIN FEES 863758 HFN INC 1315 W 22ND STREET OAK BROOK IL 60523 PREFERRED PROVIDER FEES 526672 SOMMERS & FAHRENBACH 3301 WEST BELMONT CHICAGO IL 60618 PRINTING 239226 THE SEGAL COMPANY 101 NORTH WACKER DRIVE CHICAGO IL 60606 ACTUARIAL 218983 6 EMPLOYER CONTRIBUTIONS 900099 60515484 60515484 CLAIMS REFUNDS & SUBRO 900099 589377 589377 PARTICIPANT CONTRIBUTI 900099 74491 74491 LIQ. DAMAGES,INT, & FE 900099 -40946 -40946 61138406 3141447 3141447 215395175 212725898 2669277 2669277 2669277 MISC INCOME - O/S CHEC 900099 5207 5207 5207 66954337 61138406 0 5815931 56623600 756181 99773 164018 77766 98106 43800 43934 46965 387353 153852 75854 8636 91625 19830 TEMPORARY STAFFING 141612 PAYROLL COMPLIANCE AUDI 8300 MEMBERSHIP DUES 6500 58847705 1252217 13088665 7835374 13227306 31788000 32182000 441838 240373 254242 201465 49257138 37438681 75279 207811 90462250 96345928 94615 34428 102630 207832 197245 242260 X 0 0 0 0 90265005 96103668 90265005 96103668 90462250 96345928 X 8106632 -2267969 X 0 1 1 X 0 441838 240373 201465 201465 DUE TO LOCAL NO. 4 SEIU HEALTH & WELFARE FUND 176012 DUE TO BROKER 31820 207832 66954337 58847705 8106632 -2267969 -2267969 5838663 64653156 -2267969 -2267969 66921125 33212 33212 66954337 58814493 0 58814493 33212 33212 58847705 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 3 THE BOARD OF TRUSTEES DOES NOT PERSONALLY HANDLE THE DAY-TO-DAY OPERATIONS OF THE PLAN AND HAVE DELEGATED THESE DUTIES TO A THIRD PARTY ADMINISTRATOR. FORM 990, PART VI, SECTION A, LINE 8B THE FUND DOES NOT HAVE ANY SEGREGATED COMMITTEES WHICH ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARDS REVIEW AND APPROVAL, THE FORM IS SIGNED AND FILED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,267,969. FORM 990, PART VII, SECTION A / FORM 990, PART IX, LINE 7,8,9,10. THE FUND SHARES EMPLOYEES OF THE LOCAL 4 SEIU HEALTH & WELFARE FUND, AN UNRELATED ENTITY, FOR ADMINISTRATION OF ITS HEALTH PLAN, PURSUANT TO A SHARED ADMINISTRATION AGREEMENT. THE LOCAL 4 SEIU HEALTH & WELFARE FUND COMPENSATES THESE EMPLOYEES. THIS FUND DOES NOT COMPENSATE ANY EMPLOYEES. INSTEAD, THIS FUND REIMBURSES THE LOCAL 4 SEIU HEALTH & WELFARE FUND FOR SHARED ADMINISTRATIVE EXPENSES, WHICH ARE ESTIMATED USING A COST ALLOCATION STUDY APPROVED BY THE TRUSTEES. ANY REIMBURSEMENT FOR COMPENSATION-RELATED EXPENSES ARE REPORTED IN PART IX, LINES 7-10. STATE OF ILLINOIS - DEPT OF HUMAN SVCS 100 S GRAND AVE EAST SPRINGFIELD IL 62762 CONTRIBUTING EMPLOYER IL GOVERNMENTAL UNIT N/A N/A 0 SEIU HEALTHCARE IL AND IN 2229 S HALSTED ST CHICAGO IL 60608 262160104 LOCAL UNION IL 501(C)(5) N/A N/A 0 ADDUS HEALTHCARE INC 2401 S PLUM GROVE ROAD PALATINE IL 60067 421014070 CONTRIBUTING EMPLOYER IL N/A BETHEL NEW LIFE 4950 W THOMAS CHICAGO IL 60651 363013241 CONTRIBUTING EMPLOYER IL N/A CHICAGO COMMONS 700 N SACRAMENTO STE 141 CHICAGO IL 60612 362169136 CONTRIBUTING EMPLOYER IL N/A COMMUNITY CARE SYSTEMS INC 405 N MACARTHUR BLVD SPRINGFIELD IL 62702 371083261 CONTRIBUTING EMPLOYER IL N/A FAMILY HOME SERVICE 1040 W HURON STREET FLR 2 CHICAGO IL 60642 363500504 CONTRIBUTING EMPLOYER IL N/A HELP AT HOME INC 1 N STATE ST STE 800 CHICAGO IL 60602 362820808 CONTRIBUTING EMPLOYER IL HOME CARE PERSONAL SERVICES INC 1809 N MILL ST NAPERVILLE IL 60563 363168945 CONTRIBUTING EMPLOYER IL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART II AND PART IV. THE INFORMATION REPORTED REGARDING THE FUND'S CONTRIBUTING EMPLOYERS IS THE INFORMATION THAT WAS READILY AVAILABLE TO THE FUND. WITH THE EXCEPTION OF THE STATE OF ILLINOIS DEPARTMENT OF HUMAN SERVICES, ALL OTHER EIN'S WERE AVAILABLE AND THEREFORE REPORTED IN PARTS II AND IV.