2023-11-06T12:26:03-06:00 2022-12-31 470900880 CALIBRE CPA GROUP PLLC 230 W MONROE STREET SUITE 310 CHICAGO IL 60606 990 2022-01-01 362331071 AUTOMOBILE MECHANICS' LOCAL NO 701 UNION AND INDUSTRY WELFARE AUTO 7084820110 361 S FRONTAGE ROAD BURR RIDGE IL 605276393 JENNY EARTH-GILLUND ADMINISTRATOR 7084820110 2023-11-06 1 JENNY EARTH-GILLUND 999009999 0 JOHN LEGGERO P01357710 3126550037 2023-11-06 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JENNY EARTH-GILLUND 361 S FRONTAGE ROAD BURR RIDGE IL 605276393 337551894 0 X N/A X 1956 IL TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND DISABILITY BENFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES 6 6 20 0 0 0 263175 0 90322705 104784449 16319228 -3619768 110801 125883 107015909 101290564 0 0 90738865 85003772 1568709 1725586 0 0 0 1206027 1341129 93513601 88070487 13502308 13220077 251648514 233354268 16248237 13316844 235400277 220037424 TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND DISABILITY BENFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND DISABILITY BENFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES 0 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 1 9 0 1 20 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 X JENNY EARTH-GILLUND 7084820110 361 S FRONTAGE ROAD NO 100 BURR RIDGE IL 60527 X CHRIS KONECKI TRUSTEE 1.00 X 0 0 0 SAM CICINELLI TRUSTEE 1.00 45.00 X 0 103120 30699 RONALD FETTY TRUSTEE 1.00 X 0 0 0 ROBERT KEPPLER TRUSTEE 1.00 X 0 0 0 DAVID MASHEK TRUSTEE 1.00 X 0 0 0 MARK GRASSESCHI TRUSTEE 1.00 45.00 X 0 167952 65152 STEVE BUKOVAC FUND ADMINISTRATOR 40.00 X 281220 0 57765 JEANINE EARTH-GILLUND ASSISTANT ADMINISTRATOR 40.00 X 175349 0 47178 KRISTINE BENDY ACCOUNTING MANAGER/CONTROL 40.00 X 118112 0 41454 574681 271072 242248 3 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS ADMINISTRATIVE SERVICES 2658246 PAYDHEALTH LLC 4001 MCEWEN RD STE 450 DALLAS TX 75244 CLAIMS MANAGEMENT 2535320 PROFESSIONAL BENEFIT ADMINISTRATORS 900 JORIE BLVD 250 OAK BROOK IL 60523 CLAIMS MANAGEMENT 1003835 EMPIRX 155 CHESTNUT RIDGE ROAD SUITE 201 MONTVALE NJ 07645 CLAIMS MANAGEMENT 672322 VALENZ CARE 23048 N 15TH AVENUE PHOENIX AZ 85027 CLAIMS MANAGEMENT 528886 5 EMPLOYER CONTRIBUTIONS 900099 99415474 99415474 PARTICIPANT CONTRIBUTI 900099 2618195 2618195 PRESCRIPTIONS REBATES 900099 1346627 1346627 REIMBURSED SHARED EXPE 900099 837334 837334 COBRA SUBSIDY 900099 350129 350129 216690 216690 104784449 4412617 4412617 228228945 236261330 -8032385 -8032385 -8032385 OTHER INCOME 900099 125883 125883 125883 101290564 104784449 0 -3493885 85003772 561512 737931 134863 195641 95639 324845 91712 282287 186664 201474 120045 73830 11846 12145 36281 88070487 553466 36533 4826322 8890490 7763674 11015769 349523 328649 33019 20874 223827111 194141683 14586854 19234908 58068 14011 251648514 233354268 424113 474612 15824124 12842232 16248237 13316844 X 0 0 0 0 235400277 220037424 235400277 220037424 251648514 233354268 13220077 -28582930 0 X X 0 1 X 1 0 7446 5692 1754 342077 322957 19120 20874 COMMON COLLECTIVE TRUSTS 19234908 F 19234908 FEES MANDATED BY ACA 34044 CLAIMS PAYABLE AND IBNR 12552000 DUE TO BROKER 256188 12842232 X 71588013 -28582930 -28582930 100170943 282287 837334 1119621 101290564 90153866 0 90153866 282287 -2365666 -2083379 88070487 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEES BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSEMENTS FROM PENSION FUND AND 401(K) PLAN 837,334. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSEMENTS FROM PENSION FUND AND 401(K) PLAN 837,334. INCREASE (DECREASE) IN CLAIMS PAYABLE AND IBNR -3,203,000. X 0 0 0 STEVE BUKOVAC FUND ADMINISTRATOR 281220 0 0 0 0 0 38881 0 18884 0 338985 0 0 0 MARK GRASSESCHI TRUSTEE 0 167952 0 0 0 0 0 46638 0 18514 0 233104 0 0 JEANINE EARTH-GILLUND ASSISTANT ADMINISTRATOR 175349 0 0 0 0 0 28294 0 18884 0 222527 0 0 0 KRISTINE BENDY ACCOUNTING MANAGER/CONTROL 118112 0 0 0 0 0 22570 0 18884 0 159566 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE 990 HAS BEEN PROVIDED TO THE ADMINISTRATOR FOR HIS REVIEW PRIOR TO SIGNING THE RETURN FORM 990, PART VI, SECTION B, LINE 15 SALARY POLICIES ARE SET BY THE BOARD OF TRUSTEES. ANNUAL SALARIES ARE REPORTED IN EMPLOYMENT CONTRACTS WHICH ARE REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE FORM 990 PART VII LINE 1A STEVE BUKOVAC IS THE ADMINISTRATOR, JENNY EARTH-GILLUND IS THE ASSISTANT ADMINISTRATOR AND KRISINE BENDY IS THE ACCOUNTING MANAGER/CONTROLLER OF THIS PLAN AND THE RELATED PENSION PLAN AND 401K PLAN. SALARY AND EMPLOYEE BENEFIT AMOUNTS ARE INITIALLY PAID FOR BY THIS PLAN AND REIMBURSED PERIODICALLY BY THE RELATED PLANS. FORM 990 PART XII LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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