2012-04-11T11:50:41-05:00 2011-06-30 LEGACY PROFESSIONALS LLP 311 SOUTH WACKER DRIVE SUITE 4000 CHICAGO IL 60606 990 2010-07-01 366136495 DUPAGE COUNTY CEMENT MASONS WELFARE FUND DUPA 6305307083 240 WEST ST CHARLES ROAD VILLA PARK IL 60181 JAMES F ROSSI 6305307051 2012-04-11 1 LEGACY PROFESSIONALS LLP 3123680500 2010 2016-02-24 21:20:13Z JAMES F ROSSI 240 WEST ST CHARLES ROAD VILLA PARK IL 60181 12460493 0 X N/A X 1965 IL PROVIDE HEALTH BENEFITS 6 4 1 0 0 0 0 0 2520865 2672207 295016 562969 6318 14665 2822199 3249841 0 0 3270420 3751954 347977 253337 0 0 0 311807 344549 3930204 4349840 -1108005 -1099999 8911867 8104650 862260 1192853 8049607 6911797 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 TO PROVIDE MEDICAL, LIFE, TEMPORARY DISABILITY, ACCIDENTAL DEATH AND DISMEMBERMENT, PRESCRIPTION DRUG, DENTAL AND VISION BENEFITS TO ELIGIBLE PARTICIPANTS, DEPENDENTS AND BENEFICIARIES. 0 0 0 0 0 0 0 0 1 1 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 0 1 2 0 1 1 1 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X DUANE EXLINE 6305307083 240 WEST ST CHARLES ROAD VILLA PARK IL 60181 X MICHAEL DERRICO 1.00 X 0 9450 6146 ROBERT ELLIOT 1.00 X 0 0 0 ROBERT DANNER 1.00 X 0 4104 781 STEVE BAUMGARTNER 1.00 X 0 0 0 JOHN HALLBERG 1.00 X 0 0 0 JAMES ROSSI 1.00 X 0 5250 3420 VINCE RADER 1.00 X 0 0 0 PAUL NIELSEN 1.00 X 0 0 0 DUANE EXLINE 22.00 X 0 101914 54126 0 120718 64473 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 PPO PROVIDER 139528 LEGACY PROFESSIONALS LLP 311 SOUTH WACKER STE 4000 CHICAGO IL 60606 AUDIT AND ACCOUNTING 110103 2 CONTRACTOR CONTRIB. 900099 2448717 2448717 COBRA PAYMENTS 900099 162806 162806 REBATE INCOME 900099 30638 30638 SUBROGATION INCOME 900099 30046 30046 2672207 299388 299388 9474233 9210652 263581 263581 263581 MISCELLANEOUS INCOME 900099 14665 14665 14665 3249841 2672207 0 577634 3751954 75826 90948 48254 24805 13504 23089 112922 27680 49649 30690 35044 11308 1571 27946 12464 12186 4349840 894044 1091979 325230 720250 399091 449281 17466 13033 88647 66657 25499 21990 5870914 4877661 1379623 930456 8911867 8104650 38599 38158 823661 1154695 862260 1192853 X 0 0 0 0 8049607 6911797 8049607 6911797 8911867 8104650 X -1099999 -37811 X X 0 1 1 X 0 62188 45980 16208 26459 20677 5782 21990 COMERICA LARGE CAP INDEX FUND 930456 F 930456 DUE TO RELATED ORGANIZATIONS 650504 AMOUNTS HELD IN ESCROW 28877 DUE TO BROKER 475314 1154695 3249841 4349840 -1099999 -37811 -37811 -1137810 3184350 -37811 -37811 3222161 27680 27680 3249841 4322160 0 4322160 27680 27680 4349840 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. 0 0 0 DUANE EXLINE 0 101914 0 0 0 0 0 34877 0 19249 0 156040 0 0 FORM 990, PART VI, SECTION A, LINE 8B THE FUND 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 FUND ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARD'S REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES AND THOSE EMPLOYEES OF THE FUND DETERMINED BY THE TRUSTEES TO BE KEY EMPLOYEES ANNUALLY SUPPLY A COPY OF ANY DISCLOSURE FORM REQUIRED TO BE PROVIDED TO THE DEPARTMENT OF LABOR AND IN CONNECTION WITH THE FUND'S ANNUAL AUDIT, PROVIDE A STATEMENT TO THE FUND OF ANY INTERESTS THAT COULD GIVE RISE TO A CONFLICT OF INTEREST, AS DEFINED BY THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO ANY PARTICIPANT IN THE PLAN UPON REQUEST AT THE FUND OFFICE. FORM 990, PART VII, SECIONA, LINE 1A THE REPORTING ORGANIZATION'S ADMINISTRATOR IS ALSO THE ADMINISTRATOR OF TWO OTHER ENTITIES. THE REPORTING ORGANIZATION IS REIMBURSED BY THESE ENTITIES FOR THEIR ALLOCATED PORTION OF HIS SALARY AND RELATED EXPENSES. THE AVERAGE HOURS PER WEEK REPORTED ON LINE 1A IS THE WEEKLY AMOUNT DEDICATED TO ALL THREE ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -37,811. FORM 990, PART VII, SECTION A, COLUMNS E & F SALARIES AND BENEFITS ARE ORIGINALLY PAID BY THE CEMENT MASONS 803 PENSION FUND, A RELATED ENTITY, AND THEN REIMBURSED BY THE WELFARE FUND. W-2'S ARE ISSUED BY THE CEMENT MASONS 803 PENSION FUND. ADDITIONALLY, A NUMBER OF THE TRUSTEES AND THE ADMINISTRATIVE COORDINATOR ARE INSTRUCTORS FOR THE RELATED APPRENTICESHIP FUND. THE APPRENTICESHIP FUND PAYS SALARIES AND BENEFITS FOR HOURS WORKED. THE APPRENTICESHIP FUND ISSUES SEPARATE W-2'S FOR ITS INSTRUCTORS. CEMENT MASONS LOCAL 803 PENSION FUND 240 W ST CHARLES ROAD VILLA PARK IL 60181 366136495 TO PROVIDE RETIREMENT AND DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS IL 401(A) N/A N/A 0 DUPAGE COUNTY CEMENT MASONS 803 APPRENTICE FUND 240 W ST CHARLES ROAD VILLA PARK IL 60181 366541537 TO PROVIDE A TRAINING PROGRAM FOR APPRENTICES IL 501(C)5 N/A N/A 0 DUPAGE COUNTY VACATION SAVINGS FUND 240 W ST CHARLES ROAD VILLA PARK IL 60181 364510669 TO PROVIDE EMPLOYEES WITH SAVINGS BENEFITS IL 501(C)9 N/A N/A 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 CEMENT MASONS LOCAL 803 PENSION FUND N 251352 ALLOCATED SALARIES AND BENEFITS CEMENT MASONS LOCAL 803 PENSION FUND O 75963 PY ALLOCATION & CY PERIODIC PMTS