2011-01-10T10:42:03-06:00 2010-05-31 BANSLEY AND KIENER LLP 8745 W HIGGINS RD CHICAGO IL 60631 990 2009-06-01 362151212 HEALTH & WELFARE DEPT OF THE CONSTR & GEN LBRS DIST CNCL OF CH & VICIN HEAL 7085620200 11465 CERMAK ROAD WESTCHESTER IL 60154 JAMES S JORGENSEN 7085620200 2011-01-10 1 PAUL A MERKEL 3122632700 2009 2016-02-24 21:20:13Z JAMES S JORGENSEN 11465 CERMAK ROAD WESTCHESTER IL 60154 658918504 0 X www.chicagolaborersfunds.com X 1950 IL SEE STATEMENT A 12 12 96 0 0 0 0 203258667 166056774 7859619 -2764044 0 211118286 163292730 0 167314772 167093352 6675921 7357558 0 0 4399980 4608661 178390673 179059571 32727613 -15766841 256589810 242607122 125437304 101562094 131152506 141045028 The Fund Provides Health, prescription, Dental, Vision and Loss of Time Benefits to eligible participants and dependents. 0 0 To provide Health, prescription, Dental, Vision and Loss of Time Benefits to eligible participants and dependents. 0 0 0 0 0 0 0 0 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 1 548 0 1 96 1 0 0 0 0 0 12 12 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 X X MR JAMES S JORGENSEN 7085620200 11465 CERMAK ROAD WESTCHESTER IL 60154 CHARLES GALLAGHER 2.50 X 0 0 0 ALAN ESCHE 2.50 X 0 0 0 DAVID LORIG 2.50 X 0 0 0 TIM SCULLY 2.50 X 0 0 0 RICHARD GRABOWSKI 2.50 X 0 0 0 DENNIS MARTIN 2.50 X 0 0 0 JAMES CONNOLLY 2.50 X 0 0 0 MARTIN FLANAGAN 2.50 X 0 0 0 RICHARD KUCZKOWSKI 2.50 X 0 0 0 SCOTT PAVLIS 2.50 X 0 0 0 RICHARD SHERMAN 2.50 X 0 0 0 TIM RILEY 2.50 X 0 0 0 JAMES S JORGENSEN 15.00 X 260410 0 110302 patrick wallace 20.00 X 130013 0 63920 SALLY ETZ 36.00 X 128612 0 61082 EUGENIA MASHOS 20.00 X 117563 0 59720 JERROD OLSZEWSKI 20.00 X 117960 0 61402 LORI WILLIAMS 40.00 X 117990 0 56134 872548 0 412560 8 0 1 0 THE SEGAL COMPANY 101 N WACKER DRIVE SUITE 500 CHICAGO IL 60606 BENEFIT CONSULTING AND ACTUARIAL SERVICE 370571 BANSLEY AND KIENER LLP 8745 W HIGGINS ROAD SUITE 200 CHICAGO IL 60631 ACCOUNTING SERVICES 367614 ALLISON SLUTSKY & KENNEDY PC 230 W MONROE SUITE 2600 CHICAGO IL 60606 LEGAL SERVICES 345340 LEVINSON SIMON & SPRUNG PC 566 W LAKE STREET SUITE 3 WEST CHICAGO IL 60661 ACCOUNTING SERVICES 264384 OGLETREE DEAKINSNASH SMOAK & STEWART 20 S CLARK STREET 25TH FLOOR CHICAGO IL 60603 LEGAL SERVICES 245378 5 EMPLOYER CONTRIBUTIONS 900099 158009169 158009169 SUPPLEMENTAL EARLY RET 900099 3456845 3456845 COBRA PAYMENTS 900099 3053794 3053794 GOVERNMENT DRUG SUBSID 900099 802982 802982 LIQUIDATED DAMAGES - D 900099 615375 615375 118609 118609 166056774 5727690 5727690 487134040 495625774 -8491734 -8491734 -8491734 163292730 166056774 0 -2764044 167093352 171584 4213006 1374528 1250946 347494 1215596 338753 609961 251239 811780 315936 483246 23660 211008 136714 outside seRVICES 156300 general expenses 45029 continued professional 9439 179059571 16425246 13605833 76634 61206 4349477 3991973 470904 357504 161443148 187644767 36157049 19453444 42016829 21484368 256589810 242607122 4662323 2663435 120774981 98898659 125437304 101562094 X 0 0 0 0 131152506 141045028 131152506 141045028 256589810 242607122 X 0 1 0 X 0 4167230 3822110 345120 182247 169863 12384 357504 private equity partnership 6215377 F mutual funds 10901269 F real estate investment fun 2336798 F 19453444 EMPLOYER CONTRIBUTIONS - NET OF ALLOWANCE 17069308 DUE FROM BROKERS 461583 ACCRUED INTEREST 926327 MEDICAL CLAIMS REIMBURSEMENT 2578558 DUE FROM OTHER FUNDS 448592 21484368 BANK OVERDRAFT 1537924 CLAIMS CURRENTLY PAYABLE 4116800 ESTIMATED LIABILITIES FOR CLAIMS INCURRED, NOT REPORTED 16467400 ESTIMATED LIABILITIES FOR ACCUMULATED ELIGIBILITY 63430000 ESTIMATED LIABILITY FOR HRA PROGRAM BENEFITS PAYABLE 13346535 98898659 163292730 179059571 -15766841 25659363 -4839527 20819836 5052995 188342132 25659363 25659363 162682769 609961 609961 163292730 183289137 0 183289137 609961 -4839527 -4229566 179059571 Part XI, Line 8 - Other Adjustments: decrease in benefit obligations: -4839527. Part XIII, Line 4b - Other Adjustments: DECREASE IN BENEFIT OBLIGATIONS X X 0 0 0 JAMES S JORGENSEN 260410 0 0 0 0 0 0 0 55151 55151 315561 55151 279182 44853 patrick wallace 130013 0 0 0 0 0 0 0 31960 31960 161973 31960 147410 26248 SALLY ETZ 128612 0 0 0 0 0 0 0 54974 6108 183586 6108 155213 4760 EUGENIA MASHOS 117563 0 0 0 0 0 0 0 29860 29860 147423 29860 135731 24799 JERROD OLSZEWSKI 117960 0 0 0 0 0 0 0 30701 30701 148661 30701 135203 25056 LORI WILLIAMS 117990 0 0 0 0 0 0 0 56134 0 174124 0 143631 0 Form 990, Part VI, Section A, line 8b There are no subcommittees with authority to act on behalf of the board of trustees. Form 990, Part VI, Section B, line 11 THE BOARD AUTHORIZES THE FUND ADMINISTRATOR, JAMES JORGENSEN, TO REVIEW AND APPROVE THE FORM 990 PRIOR TO THE DATE THAT FILING OCCURS WITH THE IRS. Form 990, Part VI, Section B, line 12 THE FUND'S LEGAL COUNSEL INFORMS THE BOARD OF TRUSTEES OF THEIR FIDUCIARY OBLIGATIONS AND WHAT CONSTITUTES A CONFLICT OF INTEREST. THE BOARD OF TRUSTEES DETERMINE AND APPROVE THE SALARY FOR THE OFFICE EMPLOYEES AND THE FUND ADMINISTRATOR, JAMES JORGENSEN. THE FUND ADMINISTRATOR'S SALARY IS PAID BY THE WELFARE FUND AND ALLOCATED WITH AND REIMBURSED BY THE LABORERS' PENSION FUND AND THE LABORERS' STAFF PENSION FUND. Form 990, Part VI, Section C, line 19 PARTICIPANTS OF THE FUND MAY REQUEST GOVERNING AND OTHER POLICY DOCUMENTS UPON REQUEST OR THEY MAY ACCESS certain documents from THE FUND'S WEBSITE. PART XI, LINE 2C THE PLAN ADMINISTRATOR IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THE BOARD OF TRUSTEES SELECTS THE INDEPENDENT ACCOUNTANT. LABORERS' PENSION FUND 11465 CERMAK ROAD WESTCHESTER IL 60154 362514514 PENSION FUND IL 401(A) N/A LABORERS' STAFF PENSION PLAN 11465 CERMAK ROAD WESTCHESTER IL 60154 366550487 PENSION FUND IL 401(A) N/A LABORERS' EXCESS BENEFIT PLAN 11465 CERMAK ROAD WESTCHESTER IL 60154 320017035 PENSION FUND IL N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 LABORERS' PENSION FUND N 1355530 LABORERS' PENSION FUND M 333940 laBORERS' PENSION FUND P 2089961