2021-12-05T10:34:25-06:00 2021-06-30 470900880 CALIBRE CPA GROUP PLLC 19615 S LA GRANGE RD MOKENA IL 60448 990 2020-07-01 362392752 LOCAL NO 731 I B OF T HEALTH AND WELFARE FUND 731H 6308874150 1000 BURR RIDGE PKWY BURR RIDGE IL 60527 TERRENCE J HANCOCK TRUSTEE 6308874150 2021-12-05 1 TERRENCE HANCOCK 999009999 CHARLES DIGIOVANNI P00284901 7089957180 2021-12-05 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z X TERRENCE J HANCOCK 1000 BURR RIDGE PKWY BURR RIDGE IL 60527 81163784 0 X N/A X 1953 IL TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 10 5 0 0 0 0 0 0 62054797 67881902 2004629 1756027 0 0 64059426 69637929 0 0 56940504 58100610 0 0 0 0 0 2283685 2205798 59224189 60306408 4835237 9331521 89594542 110284902 4969328 6037041 84625214 104247861 TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 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 1 305 0 1 0 0 0 0 0 0 0 0 0 X 10 5 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 1 1 0 X TERRENCE J HANCOCK 6308874150 1000 BURR RIDGE PKWY BURR RIDGE IL 60527 TERRENCE J HANCOCK TRUSTEE 0.50 40.00 X 0 316155 81244 JOHN LISNER TRUSTEE 0.50 40.00 X 0 257625 81244 THOMAS YONKER TRUSTEE 0.50 X 0 0 0 STEVE VOGRIN TRUSTEE 0.50 X 0 0 0 DALE BOLT TRUSTEE 0.50 40.00 X 0 204660 67993 JAMES BUIK TRUSTEE 0.50 X 0 0 0 MICHAEL J CORRIGAN TRUSTEE 0.50 40.00 X 0 128790 13566 CHRIS KONECKI TRUSTEE 0.50 X 0 0 0 MICHAEL RICHARDSON TRUSTEE 0.50 X 0 0 0 WALTER THIEDE TRUSTEE 0.50 40.00 X 0 134899 37340 RICHARD CLARSON ADMINISTRATOR 40.00 X 186157 0 13473 186157 1042129 294860 1 0 1 1 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 PPO PROVIDER 1736836 DESERT SHORE CAPITAL PARTNERS 4001 MCEWEN RD STE 450 DALLAS TX 75244 BENEFIT CONSULTING 1284751 DOWD BLOCH BENNETT CERVONE AUERBACH 8 S MICHIGAN AVE CHICAGO IL 60603 LEGAL 202090 MED-CARE MANAGEMENT INC 2090 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33409 UTILIZATION MANAGEMENT 155030 BUCK GLOBAL 123 N UPPER WACKER DRIVE CHICAGO IL 60606 BENEFIT CONSULTING 135889 5 EMPLOYER CONTRIBUTIONS 900099 58708753 58708753 PARTICIPANT AND RETIREE CONTRIBUT 900099 9173149 9173149 67881902 1236362 1236362 12045520 11525855 519665 519665 519665 69637929 67881902 0 1756027 58100610 142289 95453 151578 165337 175284 171817 131420 4567 24278 SHARED ADMIN EXPENSES R 1136630 SCHOLARSHIP EXPENSES 7145 60306408 14046263 7423635 1355435 462575 7503719 6303636 47504 44232 156067 127498 6746 28569 46168793 68546455 20466082 27475800 89594542 110284902 114117 384883 4855211 5652158 4969328 6037041 X 0 0 0 0 84625214 104247861 84625214 104247861 89594542 110284902 9331521 10291126 0 X X 0 1 X 1 0 156067 127498 28569 28569 COMMON COLLECTIVE TRUST NIS INTERMEDIATE FIXED INCOME FD 27475800 F 27475800 CURRENT AND INCURRED BUT NOT REPORTED CLAIMS PAYABLE 5606769 DUE TO RELATED FUNDS - NET 45389 5652158 X 79777477 10291126 10291126 69486351 151578 151578 69637929 59207561 0 59207561 151578 947269 1098847 60306408 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES. AS OF JUNE 30, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. AT JUNE 30, 2021, THE PLAN'S ADMINISTRATOR BELIEVES THAT THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO JUNE 30, 2018. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN CLAIMS PAYABLE AND INCURRED BUT UNREPORTED CLAIMS 947,269. 0 0 0 TERRENCE J HANCOCK TRUSTEE 0 301600 0 11600 0 2955 0 67447 0 13797 0 397399 0 0 JOHN LISNER TRUSTEE 0 244400 0 9400 0 3825 0 67447 0 13797 0 338869 0 0 DALE BOLT TRUSTEE 0 197080 0 7580 0 0 0 54196 0 13797 0 272653 0 0 RICHARD CLARSON ADMINISTRATOR 186157 0 0 0 0 0 0 0 13473 0 199630 0 0 0 WALTER THIEDE TRUSTEE 0 127400 0 4900 0 2599 0 23774 0 13566 0 172239 0 0 PART III FORM 990, PART VII, ITEM 5 AND SCHEDULE J, PART II RICHARD CLARSON IS THE ADMINISTRATOR OF THE FILING ORGANIZATION IN ADDITION TO PEFORMING SIMILAR DUTIES FOR BENEFIT FUNDS SPONSORED BY THE LABOR ORGANIZATION SPONSORING THIS ENTITY. HIS COMPENSATION IS PAID DIRECTLY BY THE EXCAVATING, GRADING AND ASPHALT CRAFT LOCAL 731 HEALTH AND WELFARE FUND AND A PORTION IS REIMBURSED TO THAT FUND BY THE FILING ORGANIZATION. HIS COMPENSATION IS COMPRISED OF WAGES AND NONTAXABLE BENEFITS. HE IS CONSIDERED AN OFFICER OF THE FILING ORGANIZATION FOR 990 REPORTING PURPOSES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY ADMINISTRATIVE PERSONNEL AND THE FUND ADMINISTRATOR. AT LEAST ONE TRUSTEE ALSO REVIEWS THE FORM PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE INCLUDED IN AN ANNUAL COST ALLOCATION STUDY WITH OTHER TEAMSTERS LOCAL 731 BENEFIT FUNDS. THE STUDY IS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED. 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