2012-03-08T13:48:01-06:00 2011-04-30 BANSLEY AND KIENER LLP 8745 WEST HIGGINS ROAD SUITE 200 CHICAGO IL 606312704 990 2010-05-01 510245220 CHICAGO PAINTERS AND DECORATORS WELFARE FUND CHIC 6309603322 333 PIERCE ROAD NO 410 ITASCA IL 60143 TERRENCE P FITZMAURICE 6309603322 2012-03-08 1 PAUL A MERKEL 3122632700 2012-03-08 2010 2016-02-24 21:20:13Z TERRENCE P FITZMAURICE 333 PIERCE ROAD ITASCA IL 60143 123539611 0 X N/A X 1953 IL TO PROVIDE HOSPITALIZATION, MEDICAL, AND OTHER RELATED BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 6 6 0 0 0 0 0 0 33560201 33476474 3239350 3441004 662132 941010 37461683 37858488 0 0 38225939 30809262 0 0 0 0 0 1924745 1827939 40150684 32637201 -2689001 5221287 89892483 96971584 23895642 21412762 65996841 75558822 SEE BELOW 0 0 TO PROVIDE HOSPITALIZATION, MEDICAL AND OTHER RELATED BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 1 1 0 0 1 0 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 0 0 0 0 1 1806 0 1 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X EDWARD OTSTOTT 6309603322 333 PIERCE ROAD NO 410 ITASCA IL 60143 X MARTIN TEW 2.00 X 0 0 0 RICHARD TAMBORSKI 2.00 X 0 0 0 SCOTT HALL 2.00 X 0 0 0 TERRENCE FITZMAURICE 2.00 X 0 0 0 ANDREW PERCH 2.00 X 0 0 0 NORBERT SOLTYSIAK 2.00 X 0 0 0 0 0 0 0 0 0 0 ARNOLD AND KADJAN 19 WEST JACKSON BLVD CHICAGO IL 60604 LEGAL AND COLLECTION 653352 BLUE CROSS BLUE SHIELD 300 E RANDOLPH CHICAGO IL 60601 HEALTH CARE PROVIDER 618335 OBA MIDWEST 333 PIERCE ROAD ITASCA IL 60143 THIRD PARTY ADMINISTRATOR 587614 DELTA DENTAL 801 OGDEN AVENUE LISLE IL 60532 HEALTH CARE PROVIDER 119540 4 EMPLOYER CONTRIBUTIONS 900099 30771695 30771695 EMPLOYEE CONTRIBUTIONS 900099 2542393 2542393 ERRP INCOME 900099 162386 162386 33476474 2516061 2516061 86606066 85681123 924943 924943 924943 COBRA SUBSIDY 900099 930576 930576 MEDICARE REIMBURSEMENT 900099 10434 10434 941010 37858488 34417484 0 3441004 30809262 599825 221587 180947 115463 62671 132799 7692 22487 41041 COLLECTION FEES 443427 32637201 363683 7742148 2873311 2876678 268285 271202 68588196 62706391 16946592 22398954 852416 976211 89892483 96971584 140617 121435 23755025 21291327 23895642 21412762 X 0 0 0 0 65996841 75558822 65996841 75558822 89892483 96971584 X 5221287 4340694 X X 0 1 1 X 0 0 COMMON TRUST FUNDS 22398954 F 22398954 EMPLOYER BONDS PAYABLE 158295 DUE TO BROKER FOR SECURITIES PURCHASED 935522 CLAIMS AND PREMIUMS PAYABLE 741200 CLAIMS INCURRED, NOT REPORTED 1150800 ACCRUED ELIGIBILITY 13331000 FURTURE INSURANCE PREMIUMS 40000 COBRA BENEFITS 4699038 BANK OVERDRAFT 235472 21291327 37858488 32637201 5221287 4340694 4340694 9561981 42083719 4340694 4340694 37743025 115463 115463 37858488 35462738 0 35462738 115463 -2941000 -2825537 32637201 PART XIII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN CHANGES IN BENEFIT OBLIGATIONS -2,941,000. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO OTHER COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PREPARED BY AN INDEPENDENT CPA AND IS REVIEWED AND APPROVED BY THE FUND REPRESENTATIVE PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990 AND FORM 5500 (WHICH INCLUDES AUDITED ANNUAL FINANCIAL STATEMENTS) AND SUMMARY ANNUAL REPORT AVAILABLE FOR INSPECTION UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,340,694. FORM 990, PART XI, LINE 2C THE ORGANIZATION'S BOARD OF TRUSTEES ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS. THERE HAS BEEN NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR.